PC Authorization Associate II
Overview
Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for complex outpatient hospital services, and specialized procedures (i.e. Recurring Visits, Surgeries, IR). Obtains pre-certification or pre-authorization prior to the scheduled complex service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notify payers of admittance if required.
Responsibilities
Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for complex outpatient hospital services, and specialized procedures (i.e. Recurring Visits, Surgeries, IR). Obtains pre-certification or pre-authorization prior to the scheduled complex service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notify payers of admittance if required.
Qualifications
Education
H.S. Diploma or General Education Degree (GED) Required
Bachelor’s Degree from a recognized college or university Preferred
Completion of medical coder training program Preferred
Work Experience
3 years exp in Rev Cycle or related exp in healthcare, with one of those years working specifically within Healthcare Revenue Cycle Required
4 years of previous related healthcare Revenue Cycle experience Preferred
Prior Epic experience Preferred
Clinical experience (i.e., medical assistant, surgical tech) Preferred
Licenses and Certifications
None Required
Certification with Healthcare Financial Management Association Preferred
Certified Revenue Cycle Representative Preferred
Business Unit : Company Name
Piedmont Healthcare Corporate
Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for complex outpatient hospital services, and specialized procedures (i.e. Recurring Visits, Surgeries, IR). Obtains pre-certification or pre-authorization prior to the scheduled complex service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notify payers of admittance if required.
Responsibilities
Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for complex outpatient hospital services, and specialized procedures (i.e. Recurring Visits, Surgeries, IR). Obtains pre-certification or pre-authorization prior to the scheduled complex service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notify payers of admittance if required.
Qualifications
Education
H.S. Diploma or General Education Degree (GED) Required
Bachelor’s Degree from a recognized college or university Preferred
Completion of medical coder training program Preferred
Work Experience
3 years exp in Rev Cycle or related exp in healthcare, with one of those years working specifically within Healthcare Revenue Cycle Required
4 years of previous related healthcare Revenue Cycle experience Preferred
Prior Epic experience Preferred
Clinical experience (i.e., medical assistant, surgical tech) Preferred
Licenses and Certifications
None Required
Certification with Healthcare Financial Management Association Preferred
Certified Revenue Cycle Representative Preferred
Business Unit : Company Name
Piedmont Healthcare Corporate