Precertification Prior Authorization Spec, Spn-Scheduling

Description

WHAT IT'S LIKE AT SGMC HEALTH

Purpose
. No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.

Excellence
. We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.

Team Spirit.We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.

Award Winning Performance.We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.

WHY YOU WILL LOVE SGMC HEALTH

SGMC has great benefit options, depending on the role that you are going into– including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities to expand your skill set. Some of these great benefit options are listed below:

• Low Healthcare Insurance Premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

JOB LOCATION : Professional Building

DEPARTMENT: SPN - SCHEDULNG

SCHEDULE: Full Time, 8 HR Day Shift,  M-Fri

POSITION SUMMARY

Responsible for obtaining precertification and/or prior authorization for each patient for which testing and/or procedures have been ordered by the Surgeon, prior to services being rendered, using appropriate diagnoses and procedure codes. The precertification and/or authorization must be obtained on each patient; preferably prior to their scheduled appointment. If not able to obtain precertification and/or authorization, specialist must contact the patient to reschedule their appointment.

Responsible for reviewing for accuracy of information requested and received in regard to precertification and/or prior authorization numbers received, as well as supporting documents. Responsible for uploading into SGMC EHR software system, authorization numbers, time spans/number of procedures, etc. and supporting documentation upon verification that procedures are authorized as requested. Responsible for monitoring and tracking of authorization requests and expiring authorizations.

Responsible for the use of and, documentation in, SGMC EHR software system as the official medical record, following appropriate guidelines for documenting. Responsible for contributing to department development. Perform front office reception and various customer service duties. Other duties as identified and assigned by Practice Manager.

KNOWLEDGE, SKILLS & ABILITIES

High school graduate preferred. Minimum (1) year prior administrative experience or equivalent; preferable in a hospital or medical office setting to include working knowledge of insurance and managed care. Must have excellent computer (technical and systems) skills & knowledge: PC and Windows literacy required, as well as Microsoft Office applications - Outlook, Word, Excel, etc. as well as a variety of other office machines.

Prior use of medical office software database preferred. Must possess excellent communication and interpersonal skills, and must be able work effectively as part of a team and respond well to supervision. Self-motivated, showing initiative to tackle important issues, problems and tasks. Attention to detail skills are critical; ability to manage multiple tasks, meet deadlines and be flexible in order to adapt to variety on the job;

ability to cross train to other functions as necessary. Requires flexibility in work scheduled for accountability expectations for operations and process management in a customer focused business.

WORKING CONDITIONS - ADA INFORMATION

Generally regular work schedule during normal office hours. Comfortable setting indoors. May be subjected to high levels of stress. Must be able to sit for prolonged periods of time. Moderate heavy lifting (0-25 lbs.), reaching, stooping, pushing, pulling, bending and twisting. Must be able to operate office equipment to include FAX, copier, and computer.

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