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- Communicate on a daily basis with practice managers, clinicians and staff to ensure that visits are appropriately registered, and meet all insurance pre-authorization requirements.
- Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the BronxCare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service.
- Insures authorization requests are obtained and processed for medical and ancillary services on a timely basis and manage the accurate submission of authorization requests and the entry of authorization to Allscripts Clinical Registration System
- Responds in a timely manner to the pre-authorization, authorization and pre-certification requests of various points of service areas located within BronxCare Health System’s ambulatory practices.
- Navigates Allscripts EMR (Acute Care) and communicates with Practice Administrative staff or Care providers to retrieve required clinical utilization data to facilitate insurance carrier review and expeditious authorization approval
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