Authorization and Insurance Verification Coding Lead - Requisition

All CDC recommended vaccines are required vaccinations sonally, and upon determination of Senior leadership, the Influenza Vaccine may be mandatory; in those years, compliance is required. For all vaccines, Religious Exemptions and Medical Contraindications are available.

Job Summary: Responsible for overseeing the Physician services verification and authorization process for the Organization. Provides accurate and timely insurance verification of eligibility and authorization. Audits clinical documentation to validate coding accuracy pre and post service.

Essential Functions:

• Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his/her goals and objectives in a manner that helps others to achieve their goals and objectives.
• Provides accurate and timely insurance verification and authorization for ancillary, surgical, inpatient, and physician services.
• Follows appropriate point of service collection and notification processes.
• Demonstrates accuracy in gathering information and inputting data in all phases of insurance verification and the authorization process.
• Communicates with physicians, physician offices and hospital staff to obtain clarifying documentation for correct coding validation.
• Appeals denied claims related to authorization process.
• Trains and mentor staff on insurance verification, authorization, coding validation processes and best practices.

Minimum Qualifications: 18 years of age. CCA or equivalent certification. Relevant clinical or medical experience related to healthcare insurance verification, authorization and/or coding.

Knowledge, Skills & Abilities: Knowledge of clinical and medical terminology, ICD-10 and CPT coding; computer skills. Strong leadership, verbal communication, interpersonal, organizational, customer service, and critical thinking skills. Ability to problem solve, handle conflict, and adapt to frequent change. Ability to interpret insurance records and related documentation. Ability to work independently, as well as to accept direction on given assignments.

Working Conditions: Work is generally performed within an office environment, with standard office equipment available.

Physical Requirements: Constantly sit, see/visual acuity, handle/grasp/feel, talk/hear. Occasionally lift/carry 1 to 25 lbs.