Medical Prior Authorization and Accounts Receivable Coordinator

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PROFILE SUMMARY

The Medical PA and AR Coordinator is responsible for coordinating multiple processes and activities. Submitting and tracking prior authorizations and maintaining control of pending claims are key daily tasks. Communication skills and customer service are highly regarded as key factors in securing a smooth workflow. A variety of administrative skills are necessary to achieve optimum office performance. Strong medical knowledge and terminology are required to verify medical insurance and benefits, collect copayments, deductibles and coinsurance. Work independently without significant supervision.

KEY ACCOUNTABILITIES

1. Answer phone and greet patients.

2. Submit Prior Authorization for medication and services provided by the physician.

3. Track Prior Authorization in process and notify patient and physician of status and scheduling.

4. Research and implement required adjustments to ensure that denied requests are approved.

5. File and track the status of a claim with the insurance carriers.

6. Analyze denied claims, take necessary action with patients and insurance carriers to submit additional information as needed, and refile denied claims with insurance carriers.

7. Print physician AR report and EOBs for all insurance carriers weekly to assess status of claims, post payments and establish and correct denied claims.

8. Maintain control of claims billed and pending to ensure full accountability for all claims.

9. Follow-up on all unpaid claims within the required timeframe.

10. Ensure that all items that were billed have been paid, investigate unpaid items and resubmit for payment.

11. Notify insurance companies of unpaid claims and work to ensure payment is received on all billed items.

12. Work closely with insurance carriers to collect all old and past due outstanding Accounts Receivables.

13. Collect outstanding amounts from patients as well as amounts due as patients receive treatment.

14. Demonstrate knowledge in reading EOBs and identifying outstanding line billing

15. Provide physician with monthly AR reports and meet with physician to review progress

16. Mail patient statements and collection letters.

17. Stay informed about the Medical Director files and ensure ongoing compliance is consistently maintained.

Plus - may perform other duties as assigned.

KEY INTERACTIONS

• Internal: Internal Team
• External: Insurance, Patients, Physicians

EDUCATION

• Required: High school Diploma General Education
• Preferred: Associate's degree or equivalent in related area preferred

EXPERIENCE

• 2+ years of A/R Medical Billing experience including Claims status, claims appeals, and AR follow-up
• 2+ year of experience handling Prior Authorizations

TECHNICAL / SPECIALIZED KNOWLEDGE, SKILLS, ABILITIES

• Knowledge of requirements, codes and procedures necessary to achieve a positive result from insurance.
• Familiar with Insurance HMO, PPO, Medicare and Medi-cal
• Proven basic computer skills with MS Outlook, Word, Excel and computer based medical systems.
• Understanding of HIPAA regulations.
• Knowledge of medical terminology and coding.
• Ability to communicate effectively communicate verbally and written.
• Ability to prioritize and multi-task.

BEHAVIORAL COMPETENCIES

• Planning/organizing—the individual prioritizes and plans work activities, uses time efficiently and develops realistic action plans.
• Communication—proactive communication with supervisor, physician, pharmacist, and others making them aware of challenges, concerns, and or questions.
• Attitude - they should lead by example in customer service, teamwork and expectations, helping out wherever needed.
• Customer-service - ensures that the needs of both our internal and external customers are met.
• Reliable - is seen as a “go to” person and can be trusted to do things timely, accurately and efficiently.
• Knowledgeable - in areas of medical terminology, clinical procedures, medical billing and coding and general clinical pharmacy practices; as well as medical legal, revenue cycle and health services related administrative processes

WORKING CONDITIONS

• Work Environment: Office/Infusion Center
• Physical Effort: Occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; talk or hear. The employee must occasionally lift or move office products and supplies, up to 20 pounds
• Equipment Used: Pen, Paper, Computer, Tablet, Phone
• % Travel Required: Travel is primarily local during the business day, although some out-of-area and overnight travel may be expected.

BENEFITS

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Flexible Spending Account (FSA)
• Life Insurance
• 401(k) matching
• Competitive Paid time off
• Sick Leave
• Paid Holidays
• Employee Assistance Program
• Employee Referral Program
• Employee Wellness Program
• Employee Education Program

COMPENSATION

• DOE: $23-$30