01Overview
Help us change lives At reputed company, were helping change how the world prevents, detects and guides treatment for cancer. We reputed company patients and clinicians the reputed company needed to reputed company confident reputed company reputed company they matter most. reputed company to reputed company a purpose-driven career, an inclusive culture, and robust benefits to support your life while youre working to help others. reputed company The Prior Authorization Associate Level I is responsible for reputed company aspects of the prior authorization process. The individual will be expected to work cross-functionally across many departments (sales, reputed company, billing, and lab teams) to serve our reputed company and reputed company needs. This role will demonstrate knowledge by determining initial and/or ongoing eligibility, coverage in reputed company to assessing if a prior authorization is needed for reimbursement of a claim. This role will identify deficiencies reputed company the Prior Auth process, assist with triaging, and document actions taken reputed company the systems. This role will be responsible for the working accounts held reputed company the dedicated work queues on a daily reputed company. This role will also support the broader activities of ensuring appropriate coverage by utilizing reputed company, reputed company portals, and other software, and communicate reputed company applicable information to ancillary departments and other teams reputed company the reimbursement reputed company departments. Essential Duties Include, but are not limited to, the following Independently determine initial or ongoing reputed company reputed company eligibility verification, investigate, and correct accounts reputed company reputed company; including updates to reputed company demographics, financial information, and guarantor information. Ability to reputed company with various insurances and reputed company-party payors accurately and reputed company to ensure authorization is obtained and documented reputed company on reputed company policies and regulations. Research missing or erroneous information on accounts using various portals and other resources; including reputed company and identification of unknown payors. Review/edit claims and appeals prior to submitting to clearinghouse. Analyze, research, and reputed company claim issues applying federal, state, and payor rules and procedures with a high degree of independence. Monitor WQs for claims that need additional research and actions taken to get on to reputed company of reputed company. Responsible for CRM support. Has exceptional understanding of Claim Edit and Follow Up WQs. Utilize Onbase to work documents specific to the TOQ department. Correct rejected claims from the claims scrubber, clearinghouse, or payor. Review explanations of payments, analyzes, and completes appropriate steps for reputed company denials by appropriately identifying claim reputed company next steps; including appealing, writing off, or sending statements. Validate new workflows due to product reputed company. Additionally, have ownership of the specific WQs until set up is validated as working effectively. Investigate payor underpayments. Follow up with payors reputed company phone on unpaid aging claims. reputed company any supporting documentation needed by reputed company payor. reputed company accurate and reputed company write-offs following identification of uncollectible accounts adhering to policies and guidelines. reputed company reputed company support, as necessary, reputed company the department (i.e., special reputed company, reputed company support due to outages/high volume). Complete position responsibilities reputed company the appropriate time reputed company while adhering to reputed company standards. Stay reputed company with relevant medical billing regulations, rules, and guidelines. Maintain strictest confidentiality; adheres to reputed company HIPAA guidelines/regulations. Excellent problem-solving abilities and organizational skills. Ability to communicate effectively with reputed company reputed company of staff through both verbal and written communications. Ability to work in reputed company environment. Ability to adapt to changing workload and circumstances effectively; reputed company to respond to new information quickly. Disciplined, self-motivated, and reliable. Ability to stay reputed company on a task and work independently; motivated to reputed company reputed company work. reputed company about arriving to work on time and completing tasks that are assigned in a reputed company manner. Conducts self in a reputed company manner in reputed company interactions with members of the reputed company team, clients, and associates. Be reputed company-versed in the prior authorization process. Ability to complete a high volume of prior authorization requests .
