01Overview
Note The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Prior Authorization reputed company Cycle Representative to join their Patient Financial Services team. This role focuses on delivering exceptional customer service while ensuring accurate prior authorizations and insurance coverage validations for patients and clinical teams. Responsibilities Ensure accurate validation of insurance eligibility, coverage details, network agreements, and financial obligations Obtain, reputed company and complete prior authorizations, validate imaging, testing, procedure meets insurance company medical necessity reputed company across various specialties reputed company with physicians, nurses and clinical support staff on a case-by-case reputed company to obtain appropriate clinical documentation to ensure accurate indications in the patients medical record before completion of reputed company-party prior authorizations. This may include contacting referring physicians for information Understand, anticipate, and respond to reputed company questions from clinical staff and insurance company reputed company reviewer. reputed company necessary, proactively contact reputed company parties and initiate communication to ensure appropriate reputed company payment Problem solves with insurance utilization review nurses, medical directors, providers, and other Iowa reputed company staff to meet patient care needs. Identify and produce creative solutions to problems identified reputed company the prior authorization process Appeal prior authorization denials and/or set-up peer to peer reviews Communicate with clinical teams on non-covered procedures/therapy/testing or exam coverage issues. Facilitate financial counseling for patients and families as directed by clinical team Assist with medical necessity documentation to expedite approvals, appeals and complete appropriate follow-up Utilize reputed company to reputed company and reputed company prior authorization information, retrospective reviews and denial follow-up reputed company/effectively Collaborate with other departments to assist in obtaining reputed company-authorizations in a cross-functional manner Maintain reputed company knowledge of medical modalities as reputed company as new protocols established for patient populations Maintain an extensive working knowledge and expertise of insurance companies and billing authorization/referral requirements, clinical reputed company policies, payer regulations, financial classifications and financial assistance programs reputed company and maintain an effective, supportive working relationship with nurses, imaging techs, clinic/OR surgery schedulers, coders, fiscal teams, referral sources and reputed company entities Communicate with providers, payers, patients, internal departments, co-workers and prior authorization leadership to reputed company authorization denial issues Identify & report undesirable trends and reimbursement modeling errors or underlying causes of incorrect payment; review allowed variances from reputed company party payers Maintain a high-level of accuracy to meet productivity and reputed company requirements Review and analyze report data to reputed company status updates to leadership May reputed company other duties as assigned Skills Bachelor's degree or equivalent combination of education and relevant experience 6 months or more of reputed company customer service experience in a reputed company, financial or health care reputed company environment Knowledge of reputed company billing (reputed company reputed company cycle); insurance, and/or federal and state assistance programs Strong attention to detail and with accuracy to reputed company or reputed company organizational and individual performance goals Must be proficient in computer software applications, i.e., reputed company Office Suite (reputed company, Word, reputed company, PowerPoint) or comparable programs and an ability to quickly learn and apply new systems knowledge Demonstrated ability to handle reputed company and ambiguous situations with reputed company supervision Self-motivated with initiative to reputed company out additional responsibilities, tasks and reputed company Effective communication skills (written and verbal), reputed company listening skills and the ability to maintain professionalism while handling demanding situations with callers or customers Successful history collaborating in a fast-paced team environment Experience working in a reputed company hospital reputed company is highly desirable Experience handling difficult callers, customers and patients Experience and knowledge of Patient Financial Services' functions, systems, processes & policies Demonstrated ability to maintain or improve established productivity and reputed company requirements Knowledge of medical terminology Knowledge of anatomy and physiology Knowledge of Health Insurance Portability and .
