Prior Auth Coordinator
Company: Wilson Medical Center
Location: Wilson
Posted on: April 30, 2024
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Job Description:
Who We Are:People are our passion and purpose. Work where you
are appreciated for who you are not just what you can do. At Wilson
Medical Center, a 294-bed facility, we bring new and innovative
programs to those who matter the most - our community. With great
pride, we offer Growing Tree Child Care Center on-site daycare
where children are offered a nurturing, safe environment centered
around the needs of each child. Where We Are:Wilson residents enjoy
a community rich in educational, cultural, and social
opportunities. We are home to numerous athletic and water sports,
festivals, and arts and entertainment venues. From the beach to the
mountains, in Wilson, you are within easy driving distance of all
that North Carolina has to offer. Why Choose Us: - - - - - Health
(Medical, Dental, Vision) and 401K Benefits for full-time employees
- - - - - Competitive Paid Time Off / Extended Illness Bank package
for full-time employees - - - - - Employee Assistance Program -
mental, physical, and financial wellness assistance - - - - -
Tuition Reimbursement/Assistance for qualified applicants - - - - -
Opportunities for education and training through a partnership with
Duke LifePoint Healthcare - - - - - Growing Tree On-Site Childcare
Facility - - - - - And much more---Position Summary:The Prior
Authorization Coordinator is an essential part of a
multi-disciplinary team that provides high-quality patient care.
The Prior Authorization Coordinator processes all inbound prior
authorizations for the department. Prior Authorization Coordinator
will coordinate and ensure the smooth flow of the authorization
process to meet the needs of our patients, community specialists,
and physicians to represent a professional and positive experience.
This candidate will review chart documentation to ensure the
patient meets medical policy guidelines, prioritize incoming
authorization requests according to urgency, obtain authorization
via the payer website or by phone, follow up regularly on pending
cases, initiate appeals for denied authorizations, and respond to
clinic questions regarding payer medical policy guidelines.
Candidates will also confirm the accuracy of CPT and ICD-10
diagnoses in the procedure order as well as maintain individual
payer files to include up-to-date requirements needed to
successfully obtain authorizations. The candidate must be at ease
interacting with patients, physicians, and insurance companies to
create relationships that will promote a pleasant and caring
practice. This role also includes ensuring that other positions
within the practice are being covered and providing a smooth and
positive atmosphere for patients, physicians, and fellow
workers.ESSENTIAL FUNCTIONS Responsible for patient and insurance
verification using automated eligibility verification systems
Communicate with appropriate parties to obtain medical
referrals/authorizations and ensure patient and insurance financial
obligations are validated and met prior to patient's visit Develop
relationships with other Dr. Offices, maintain and foster network
of contacts for promoting practice services Use Electronic Medical
Records for scheduling/maintaining patient records and appointments
Ability to do medical assistant and/or front desk responsibilities
when needed (training would be provided) Other duties may be
assigned if determined in the best interest of the Practice
Compliance, HIPAA, and Security Employees acknowledge that
compliance with CarePoint's HIPAA, Security, and Compliance Plan
policies and procedures as well as all other CarePoint policies and
procedures is a condition of employment and that any violation will
result in sanctions up to and including termination based on the
type and severity of the violation. Access to and use of Protected
Health Information - security clearance that allows employees to
review, investigate, and respond to questions from payors. EEOC
Statement:Wilson Medical Center is committed to providing Equal
Employment Opportunities for all applicants, and employees while
complying with all applicable laws prohibiting discrimination
against any employee or applicant for employment because of color,
race, sex, age, religion, national origin, disability, genetic
information, gender identity, sexual orientation, veterans' status
or any other basis protected by applicable federal, state or local
law.Minimum QualificationsJOB REQUIREMENTS Minimum education: High
School DiplomaMinimum Work Experience Minimum 1-2 years of
healthcare experience. -Minimum 1-2 years of Medical Office
experience. Work experience in radiation oncology practice is
preferred. -Required Skills: Critical thinking skills, decisive
judgment and the ability to work with minimal supervision.Equal
opportunity and affirmative action employers and are looking for
diversity in candidates for employment:
Minority/Female/Disabled/Protected Veteran
Keywords: Wilson Medical Center, Cary , Prior Auth Coordinator, Other , Wilson, North Carolina
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