Prior Authorization Specialist bei Texas Tech University Health Sciences Center El Paso
Texas Tech University Health Sciences Center El Paso · El Paso, Vereinigte Staaten Von Amerika · Onsite
- Junior
- Optionales Büro in El Paso
Position Description
procedures, treatments and services.
Optional Attachments
Travel Required
Major/Essential Functions
- Handle authorization process and obtain pre-certification approvals prior to service.
- Submit pre-authorization requests and follow up with payer to ensure timely approvals.
- Update resident providers and supervising faculty of delays related to pre-authorization.
- Assist providers with treatment plan assessment to determine if pre-authorization is required.
- Assist in the development and maintenance of a standardized workflow for the pre-authorization process.
- Provide instruction and guidelines on coding and pre-authorization processes to faculty, residents and staff.
- Assist in the preparation and submission of appeals for denied authorizations, including but not limited to providing additional information or documentation.
- Respond and follow-up to patient and insurance inquiries/correspondence in a timely manner and in accordance with departmental expectations/requirements.
- Provide leadership team with regular status updates on authorization and denials.
- Maintain accurate records and reports of pre-certifications request, approvals, and denials.
- Review assigned electronic health record (EHR) Work Queue’s to ensure all errors are cleared and billing has been submitted in a timely manner, and in accordance with departmental expectations/requirements.
- Stay current with changes in coding guidelines, regulations and insurance requirements.
- Assess and monitor Medicaid/CHIP billing guidelines and regulations while partnering with the Office of Institutional Compliance on corrective action plans related to billing compliance.
- Collaborate with revenue cycle team via weekly, biweekly, and/or monthly meetings (as directed) to review payment and denial trends.
- Collaborate with members of clinic administration on process improvement to help optimize the pre-authorization processes in the clinics.
- Communicate with patients regarding authorization requirements, status updates and financial responsibilities associated with approved or pending authorizations.
- Serve as a liaison between clinical providers and insurance payers to address authorization-related issues or inquiries effectively.
- Escalate matters of concern to leadership in accordance with departmental expectations/requirements.
- Adhere to all policies, procedures and practices (Regents Rules, TTUS, HSECEP OPs, etc.).
- Personally demonstrate, display and act in accordance with TTUHSC EP's Values (Service, Respect, Accountability, Integrity, Advancement, and Teamwork). Serve as a Value's ambassador while actively promoting and encouraging staff across the institution.
- Remains current with all licensure, certifications and mandatory compliances and trainings required of this position.
- Perform all other duties as assigned.
Grant Funded?
Minimum Hire Rate
Pay Basis
Work Location
Preferred Qualifications
- PACS, CHAA or CMA certification.
- Previous experience providing support to multiple medical sub-specialties/clinics.
- Previous experience working in an academic medical/health sciences center.
- Excellent communication (verbal and written) and interpersonal skills.
- Knowledge of basic medical terminology.
- Knowledge of CPT and ICD-10 coding. Familiarity with payer authorization processes.
- Ability to apply a strong attention to detail to work while meeting required deadlines, targets, goals, and/or metrics.
- Bilingual in English and Spanish.
Campus
Department
Required Attachments
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Pay Statement
Job Group
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EEO Statement
Required Qualifications
- Associate's degree plus one (1) year of experience directly related to the processing of prior authorizations; OR
- High school diploma or GED plus current certification as a Prior Authorization Certified Specialist (PACS), Certified Healthcare Access Associate (CHAA), or Certified Medical Assistant (CMA); OR
- High school diploma or GED plus three (3) years of experience directly related to patient registration, patient scheduling, patient billing/collections, and/or the processing of prior authorizations.