Prior Authorization- Invasive team

Patient Connection Authorization Associate II



KEY RESPONSIBILITIES:

Obtain pre-certifications, authorizations and referrals to ensure managed care compliance through either direct contact, website, or insurance tool.

Enter authorization and all pertinent information into EPIC including whom spoken to.

Apply critical thinking skills to identify and resolve opportunities to avoid a denial from payers or the insurance companies to maximize reimbursement.

Follow Piedmont policies and procedures for requirements that the payers (insurance companies) have for the procedure scheduled.

Strive for positive patient experience.

Obtain, enter, and update demographic and other financial and clinical information necessary for financial clearance of scheduled patient accounts.

Ensure all required data elements are collected and validated for account creation in Revenue Cycle systems.

Ensure payer is notified of admittance if required.

Strong ability to estimate patient financial responsibility for complex procedures.







Requirements

MINIMUM EDUCATION REQUIRED:

High School graduate or GED



MINIMUM EXPERIENCE REQUIRED:

3 yr exp in Rev Cycle or related exp in healthcare, with one of those years working specifically within Healthcare Revenue Cycle.



MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

None.