Authorization Advocate (768)

JOB SUMMARY: The Authorization Advocates are a critical part of the Network Navigation department. This role is responsible for checking authorizations / pre-certifications, ensuring that orders match the location in which it has been pre-certified / authorized for and processing referrals in an efficient and timely manner. Authorization Advocates are responsible for working with physicians, physician offices, insurance companies and their peers to answer patient questions and resolve patient issues. Additionally, this role may require staff to assist in scheduling patients after receiving their pre-cert / authorization.

The Authorization Advocate must be self-driven and able to multitask and prioritize their work. They must have strong communication skills with an understanding of medical terminology and be able to deal effectively with others. This position is team-oriented and contributes to achieving department goals.

QUALIFICATIONS:

JOB SPECIFIC CORE COMPETENCIES:

• Customer Service-oriented: The Authorization Advocate should be extremely customer service-oriented, with a patient first attitude.

• Communication skills: The Authorization Advocate will have strong written and verbal communication skills, and excellent spelling. Demonstrated knowledge of medical terminology. They will have excellent communication and interpersonal skills, especially when it comes to interacting with patients and other hospital associates over the phone or in person if required.

• Organizational skills: This role requires strong administrative and organizational skills to help manage responsibilities effectively.

• Attention to detail: The Authorization Advocate should have the ability to multitask and maintain a strong attention to detail, with good analytical and problem solving skills

• Technical skills: Proficiency in Microsoft Office suite (Outlook, Excel, Word); experience with Meditech preferred but not required.

• Ability to function independently and as a team player in a fast-paced environment.

• Strong written and verbal communication skills and excellent spelling

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Independently able to retrieve orders from worklists.

• Able to verify provider orders, authorizations, and locations ? ensuring that all information match perfectly.

• Access insurance company databases to gain prior authorizations and pre-certifications.

• Detailed and accurate chart documentation outlining details set forth by department protocol and insurance regulations outlining precertification information for the patient.

• Process referrals efficiently including gathering detailed medical records, contacting the patient to provide updates on their referral status and faxing the referral to the appropriate specialty office.

• Process pre-certifications efficiently including gathering detailed medical records and contacting the patient to provide updates on their order status

• Ongoing communication with specialty offices to ensure that patients have been scheduled with the specialty office they have been referred to

• Excellent and continuous communication between the patient, provider offices, insurance companies and peers

• Maintain patient confidentiality as defined by state, federal and company regulations.

• Validates benefit coverage per established procedures.

• Performs any other task related duties as assigned by the Director.

• All obligations pertaining to the position?s description is subject to change at any time.

• Demonstrate ability to schedule, re-schedule and cancel patients? appointments throughout Hancock Health

• Demonstrating ability to schedule, re-schedule and cancel patient appointments throughout Hancock Health

• Other Duties as assigned by manager or director.

COMPETENCIES

Demonstrates the following competencies:

• Communication and Interpersonal

• Focus on the needs of the patient with each interaction.

• Answers phone calls promptly and courteously with a smile to provide a positive impression of Hancock Health.

• Directs calls appropriately for patient assistance.

• Effectively communicates in a timely and professional manner

• Answer high-volume inbound customer calls via an automated phone system

• Make outbound calls to patients, referrals, and sales as needed

• Utilize resources to troubleshoot and resolve patient issues

• Dedicated to providing best first impressions for our patients, visitors, physicians, and associates.

• Demonstrated oral communication skills needed to develop patient rapport and ability to independently address patient needs as appropriate.

• Resolves all clinical questions within scope of knowledge while providing excellent customer service on the phone and/or in person

• Schedules any necessary follow up appointments for patients, including any specialty or ancillary services as possible

• Assists with referrals and pre-certifications, at the time of encounter

• Properly utilizes and maintains patient recall and reschedule lists

• Maintains a high regard for confidentiality and abides by organizational and HIPAA guidelines, privacy practices, patient confidentiality, and patient rights

• Schedule patient appointments or tests/procedures by interpreting physician orders, by patient need, or by established protocols. Provide patient with instructions or preparation for the test/procedure.

• Technical

• Demonstrated knowledge of medical terminology.

• Responsible for referral coordination and troubleshooting scheduling and referral issues for patients with multiple departments.

• This position manages complex appointment scheduling linking clinical visits, consults and ancillary services

• Obtains accurate patient information necessary for medical records, governmental requirements, billing, and third-party payer needs.

• Electronically validates medical, demographic, insurance and financial data in a timely and courteous manner.

• Explains pre-appointment preparation requirements

• Provides patient education about coverage and liabilities; communicates possible payment obligations and personally connects patients to a financial counselor if needed

• Demonstrated reading skills to interpret instructions, manuals, insurance information, physician instructions and patient correspondence.

• Organizational

• Establishes files, maintains information, and scans medical records in a timely and organized manner

• Processes multi-channel messages related to patient and/or physician requests regarding appointments, referrals, prescriptions, and complaints.

• Accurately performs medical record maintenance and releases

• Scan necessary documents into electronic health record

• Maintains accountability for accuracy of data collected and entered into systems.

• When needed, checks and confirms patient benefits prior to scheduling

• Performs other duties as assigned.

EXPECTED BEHAVIORS:

Attitude/Customer Competencies

• Caring, compassionate, and approachable in all customer contacts

• Privacy ? respects customers? right to privacy and modesty

• Confidentiality ? maintains customers? confidentiality

• Telephone etiquette ? speaks so that customers hear a smile

• Appearance ? takes personal ownership of appearance and that of work environment

• Initiative ? takes necessary steps to fix problems immediately

• Providing Direction and Customer Acknowledgment ? provides personalized attention by being courteous, friendly, and helpful when responding to customers? needs

• Timely service ? recognizes that customers? time is very valuable; provides them with prompt service

• Customer information/education ? provides customers with the best information needed to make informed choices

Relationship Competencies/Work Group Competencies

• Demonstrates advocacy, respect and truth telling

• Demonstrates accountability for own actions

• Demonstrates the ability to respectfully address interpersonal conflicts

• Takes initiative to help others

• Demonstrates a learning attitude toward solving problems

• Demonstrates openness to change and new learning

• Reports to work on time and has regular attendance

• Adheres to practice defined dress code

• Attends staff meetings

Ethical Decision-Making

• Respects the needs, expectations and rights of all individuals

• Advocates the rights of all to a safe environment

• Uses sensitivity to cultural diversity to guide decision-making