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Complete prior authorization templates per payer requirements to ensure medication orders will be covered by insurance plans. Processing of prior authorization responses via CoverMyMeds and submitting appeals if requested by patient/prescriber.
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This position will be responsible for but not be limited the following functions: timely and accurate creation of accounts, insurance verification pre-authorization, notification, pre-determination, and financial clearance of accounts prior to service.
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May also perform duties for prior authorization, referrals (incoming/outgoing), good faith estimates, and/or payment collections. 4 - Thoroughly and accurately documents insurance verification information in the system, identifying deductibles, copayments, coinsurance, and policy limitations.
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Perform insurance verification and prior authorization for patients prior to patient’s schedule appointment or procedure. Interview patients to obtain pertinent registration information, assure document scanning, retrieving, and editing, and patient identification to determine patient’s insurance coverage, limitations and communicates to patient any co-pays or deductibles for collection.
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Patient Access has numerous procedural requirements including data elements, insurance verification, authorization for services, and collections for all patient portions including prior balances.
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JOB DUTIES AND RESPONSIBILITIES:Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure medication prior authorizations.
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May be responsible for verifying insurance coverage and obtain prior authorization. May schedule patient appointments and obtain insurance verification and/or authorization.
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For Mobile Radiology and Oncology, CPR Certification must be obtained prior to hire. + May perform preliminary screening of patients prior to procedures, which may include medical history.
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Essential knowledge within and out of network insurance, insurance verification, patient responsibility, and process for prior authorization is required. Prior Authorization Specialists QualificationsA High School Diploma or GED is required.
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Experience with electronic insurance and benefit verification, Pre-Registration and/or Prior Authorization activities in healthcare business/office setting. Verify insurance eligibility and completes automated insurance eligibility verification, when applicable and appropriately documents information in Epic.
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Patient Assistance:May perform preliminary screening of patients prior to procedures, which may include medical history. The Patient Coordinator is responsible for performing a variety of customer service and patient care tasks to ensure a positive patient experience.
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Minimum Two (2) years’ experience of Hospital/Healthcare in Financial Investigations and/or Insurance Verification and/or Insurance Authorization. The Central Registration Financial Investigator secures prior-authorization as needed for outpatient consultative and ancillary services offered within the BronxCare Healthcare System.
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Assists eligibility specialists in the verification of insurance information, Medicaid and charity processing, and other tasks as needed. Completion of pre-registration and registration tasks including, but not limited to, the registration of patients at the time of service, or prior to the date of service while attempting to collect the patient's financial liability.
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Notify parents of the need for completed insurance referral form or pre-authorization prior to scheduled/unscheduled appointments. Verify insurance information is complete prior to procedure and collect and verify pre-authorization/referral information: goal is to obtain authorizations 5 days in advance of service.
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One (1) or more years of Admissions, Patient Registration, Scheduling, Insurance Verification, Pre-Registration, Collections, Prior Authorizations, Payor Authorizations, Call Center, customer service, or data entry, or healthcare experience, with a proven track record of accomplishing high quality work in a professional manner.
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