Job Description

 POSITION SUMMARY: Performs a variety of functions within the Patient Access Department related to obtaining prior authorization for provider visits, testing and procedures. Understands the importance North Country Healthcare places on providing exemplary customer service. Completes other tasks as assigned by management.  

POSITION REQUIREMENTS 

Education 

High School Diploma or equivalent  

Licensure 

Not required 

Certifications 

Not required 

Skills 

Good communication and customer service skills with a pleasant, clear speaking voice. Must have good organizational skills with the ability to prioritize workload. 

Work Experience 

One (1) year of hospital or health care experience in registration or business office environment preferred. Must demonstrate knowledge and use of applicable software applications. Knowledge of medical terminology and insurance preferred. Basic knowledge of CPT and ICD-10 coding preferred. 

Scheduling/availability 

This is a 24/7 department, requiring flexibility to work various shifts, including days, evenings, overnights, weekends, and holidays as needed. Schedules may vary based on department needs, and on-call responsibilities may apply. 

ESSENTIAL FUNCTIONS:  

  1. Processes incoming and outgoing referrals for patients requiring authorization at the time services are requested.  
  1. Determines insurance eligibility and benefits for requested services.  
  1. Monitoring of assigned worklists, prioritizing urgent requests. 
  1. Performs medical necessity screening as required. 
  1. Obtains necessary clinical documentation from the ordering provider to use in the authorization process.  
  1. Effectively communicates clinical information to insurance or prior-authorization company in order to obtain authorization for requested services. 
  1. Follows up with the patient, insurance company, or provider if there are insurance coverage issues in order to obtain financial resolution.  
  1. Documents referrals/authorization/certification numbers in the electronic medical record.  
  1. Maintains familiarity with insurance carrier authorization requirements.  
  1. Processes referrals within 72 hours of receipt.  
  1. Process high priority referrals within 24 hours of receipt. 

 

NON-ESSENTIAL FUNCTIONS:  

  1. Performs additional duties as assigned.  
  1. Adheres to facility Values, Service Excellence, and Standards of Excellence.  

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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