Pre-Authorization Representative - The Heart Center In Poughkeepsie, NY

Title: Pre-Authorization Representative

• The Heart Center in Poughkeepsie, NY - Full Time/40 hours per week, 8 hour shifts 8:00am

• 4:30pm.

Summary: Serves as the coordinator for all scheduled and pre-authorized procedures. The incumbent will serve as an authoritative source reconciling and updating the authorization numbers in that database from the hospitals' systems and generate a work list of authorizations needed.

Responsibilities:

1. Performing daily reconciliation of scheduled procedures, documenting authorization numbers obtained by others, as well as obtaining any authorizations and retroactive authorizations.

2. Communicates with insurance providers about the patient's medical necessity and obtains authorization for needed authorizations and reconciles to the authorization database and / or hospitals' systems.

3. Corrects inaccurate information, CPT and ICD9 codes that prohibits pre-authorization. your being secured and charges being entered into Allscripts (i.e., match patient demographic information, services performed, and authorization number with appropriate patient account).

4. Recommends revisions and modifications to improve the integrity of the pre-authorization process for better identification of procedure to be performed.

5. Reconciles, updates and obtains retroactive authorization (numbers -from insurance providers)

6. Serves as a liaison and primary contact for Heart Center managers, physicians, clerical staff and other appropriate staff.

7. Acts as a liaison to, communicating frequently (and as necessary) with Admitting and Outpatient Services serving as a representative and advocate on classification and data issues for consistent authorization.

8. Creates a monthly report listing accounts that required retroactive authorization. Maintains case list, monitors, evaluates and reports regularly the number of cases to be verified. Prepares a monthly log, and present informational reports to appropriate staff.

9. Determines and communicates to appropriate faculty and staff missing charges for cases.

10. Participate in annual and on-going mandatory compliance training. Keeps informed of changes in policy by reviewing regular Medicare bulletins and other relevant resources.

11. Be knowledgeable compliance requirements with all federal and state health care laws, regulations, and rules (including Medicare and Medicaid billing requirements that are applicable to the employee's job duties).

12. Other duties as assigned

Other information:

• Required: High school diploma required or GED. College preferred. CPC preferred.

• Comprehensive knowledge of third party insurance billing policies and procedures and previous billing experience required.

• Excellent communication and organizational skills. Minimum of two years related work experience.

• Demonstrated proficiency using PC's and hospital systems including

• Familiarity with Microsoft Access, Excel and Word preferred.

• Demonstrated understanding of medical terminology.

Salary Range:

$17.0667 - $32.4693 hourly (Pay per years of relative experience)

EOE, including disability/vets.

Nuvance Health has a network of convenient hospital and outpatient locations

• Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care. Non-acute care is offered through various affiliates.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.