Scheduling Clerk​/Prior Auth Assistant

Scheduling Clerk / Prior Auth Assistant

The Scheduling Clerk Prior Auth Assistant is responsible for obtaining prior authorizations for diagnostic exams and procedures when required by the patient’s health insurance company. The Scheduling Clerk Prior Auth Assistant routinely communicates and collaborates with patients, insurance companies and other departments and healthcare providers. The Scheduling Clerk Prior Auth Assistant is also responsible and accountable for the schedule of procedures, pre-registration of patients and checking medical necessity of procedures as required.

Acts as a liaison between patients and hospital staff and works to resolve problems.

Schedule:

Monday - Friday day shift.

Pay based on experience starting at $16.94
. Estimated Compensation Range: $16.94 - $26.26.

• Communicates with providers, hospital ancillary departments, and patients when tests and/or procedures are not approved by payer.
• Completes accurate and timely prior authorization for all applicable third‑party payers utilizing the internet, phone, and fax to ensure prior authorization is complete prior to date of service of test/procedure.
• Completes accurate and timely retrospective prior authorization for all hospital admissions, Observation Services, Swingbed, ED visits for patients with Veteran’s Administration coverage, and “Stat” diagnostic orders that require prior authorization.
• Completes insurance eligibility review to ensure insurance coverage is effective for the date test/procedure ordered.
• Completes preregistrations for all patients (as appropriate) with scheduled admissions, diagnostic tests, outpatient procedures, etc. in the Electronic Health Record system. Responsible for collecting and verifying all patient demographics, physician, and insurance information.
• Contacts no show patients to reschedule appointments.
• Obtains Physician’s written orders and ensures orders match scheduled procedures.
• Schedules patient diagnostic test(s) in a timely and accurate manner so not to delay patient care.
• Serves as a customer service representative and acts as a liaison among patient, family, staff and medical staff. Initiates problem resolution as needed.
• Verifies that all necessary data elements needed for authorization (e.g., CPT codes, diagnosis and codes, medical records, etc.) are available.

• High School (Required).