Job Summary
The prior authorization clerk is responsible for ensuring that payers are prepared to reimburse Uintah Basin Healthcare for scheduled services in accordance with the payer-provider contract. The clerk contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. Identifies prearranged payment plans and follows instructions as outlined by the Patient Access Manager. Requests and collects self-pay balances per organizational guidelines.
Duties and Responsibilities
- Demonstrates Competency in the Following Areas:
- Verifies patient's insurance and benefits information.
- Obtains prior authorizations from third-party payers in accordance with payer requirements.
- Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
- Works with other departments to gather the clinical information required by the payer to authorize services.
- Maintains accurate records of authorizations with EMR.
- Refers accounts to financial counseling as needed if authorization is not obtained.
- Works with business office staff to support appeal efforts for authorization-related denials.
- Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.
- Maintains a professional tone at all times when communicating with patients and payer representatives.
- Performs all other duties as assigned by departmental leaders.
- Accurately and thoroughly collects, analyzes, and records demographic, insurance, financial, and clinical data in a computer system. Ensures the information source is appropriate.
- Updates and edits information in the computer system, ensuring that all fields are populated correctly and appropriately.
- Obtains information and completes Medicare Secondary Payer Questionnaire and other payer-specific documents as required.
- Posts payments within the billing system.
- Ensures that all monies collected are secured or turned over to appropriate associates.
- Refers patients to Financial Counselors for in-depth financial counseling.
- Ability to perform a variety of tasks, often changing assignments on short notice.
- Must be adept at multi-tasking.
- Readily identifies work that needs to be performed and completes it without needing to be told.
Professional Requirements
- Ensures that appearance and personal conduct are professional at all times.
- Excellent attendance record.
- Wears appropriate clothing for job functions. Wears ID badge.
- Works at maintaining a good rapport and a cooperative working relationship with physicians, administration, and staff.
- Represents the organization in a positive and professional manner in the community.
- Maintains patient confidentiality at all times.
- Complies with all organizational policies regarding ethical business practices.
- Exceptional organization and time management skills.