Receptionist​/Prior Auth Clerk- Urology Clinic

Description & Job Summary

Provides a broad range of clerical functions for physicians and patients.

• Greet patients, visitors and co-workers in a prompt, courteous, and helpful manner.
• Maintain appointment scheduler and follow office-scheduling policy.
• Register patients in a complete and accurate manner to conform to all regulatory requirements.
• Collect monies at time of service.
• Reviews provider medical records to gather information for approvals from the various insurance plans.
• Handle pre-certification and referrals.
• Handles all prior authorizations on test as well as medications.
• Follow up on prior authorizations; ensure that they are completed prior to scheduled date.
• Answers the phones.
• Relays messages to and from the providers to the patients.
• Ensures the end of day reconciliation is complete each night before close.
• Perform basic clerical duties as required.
• Initiates and process prior authorization requests from healthcare providers for medical procedures and surgical services.
• Verify patient insurance coverage and benefits to determine requirements for prior authorization and collaborate with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes.
• Maintain accurate records of authorization requests, approvals and denials.
• Communicate with providers and front-end office, insurance companies, and patients regarding authorization status, requirements and appeals.
• Prepare and submit prior-authorization appeal requests as necessary.
• Communicates with patients their copay, out-of-pocket, co-insurance and deductible amounts.
• Familiarity with insurance plans, authorization processes and coverage policies.
• Accurate data entry and record keeping.

• As assigned.

• Knowledge of office equipment and ability to handle multi-time telephones.
• Basic math and computer skills.
• Proficiency in using electronic medical records systems.
• Understanding medical terminology, procedures, and healthcare regulations.
• Clear and effective communication and verbal skills.
• Accurate data entry and record keeping.
• Ability to resolve issues related to authorization request and denials.
• Ability to work independently and professionally.

Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.

Treats all information and data within the scope of the position with appropriate confidentiality and security.

Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.

• Education – High school diploma or equivalent.
• Work Experience – Customer service, familiar with using computers. Experience in a healthcare setting preferred. Previous experience in medical billing and insurance authorization preferred. Good communication skills required, bi-lingual capabilities preferred.
• Ability to work overtime to meet deadlines or handle urgent authorization requests.
• License/Certification – N/A
• Training: – N/A

Work environment consists of daily patient contact, which may include exposure to blood, or other body fluids.

Artesia General Hospital