Summary

SummaryThe primary duty is to identify the patient’s insurance that requires pre-authorization for scheduled OP Therapy, and ensuring it is obtained. Responsible for accurately documenting pertinent authorization information in all related billing systems. Responsible for benefit verification for identified services and communicating benefit details to requesting department. Effective communication to the patient regarding lack of authorization our out-of-network services. Responsible for evaluating each account individually, in a timely manner, to determine the appropriate precertification requirements based on established criteria. This role is key to securing reimbursement and minimizing organizational write-offs by following up on denials and appeals to obtain approval from insurance companies. Responsible to fill in as OP Therapy Scheduling Representative as needed. Requirements include the ability to perform at a high level and multi-task in a fast-paced environment; excellent communication, attention to detail, problem-solving, troubleshooting, and time management skills. Coworkers must be able to adapt to constant change and perform in a stressful environment. Coworker is responsible for data integrity in all systems utilized for job functions. Responsible for the delivery of Parkview Health Standards of Behavior, quality performance, and service excellence.

EducationMust be a high school graduate or the equivalent with GED. Medical terminology preferred.

Licensure/CertificationAddendums are required for 0153 Nurse Leader, 0249 Registry RN, 0252 Registered Nurse, 0235 Advanced Registered Nurse, and 0236 Expert Registered Nurse. To view addendums, go to the job description page on Parkview’s intranet.

ExperienceMinimum of two years of experience in a health care setting, call center, or clerical position, including experience using Microsoft Office applications preferred. Registration experience preferred. One year insurance pre-authorization experience preferred.

Other QualificationsMust have excellent verbal and written communication skills. Must be able to demonstrate a working knowledge of general computer skills and applications. Demonstrate ability to multi-task and work independently using critical thinking skills. Professional appearance and adherence to the clinic/facility dress code is expected. Must be willing to work at other locations as assigned.