ARKANSAS CHILDREN'S IS A TOBACCO FREE WORKPLACE. FLU VACCINES ARE REQUIRED. ARKANSAS CHILDREN'S IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, NATIONAL ORIGIN, AGE, DISABILITY, PROTECTED VETERAN STATUS OR ANY OTHER CHARACTERISTIC PROTECTED BY FEDERAL, STATE, OR LOCAL LAWS.
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Work Shift:
Day Shift
Time Type:
Full time
Department:
CC017115 Outpatient Prior Authorizations
Summary:
Monday - Friday, 8:00 a.m. - 5:00 p.m. - Onsite
Communicates with 3rd party payers regarding clinical justification and preauthorization for outpatient procedures. Obtains the appropriate CPT/ICD-10 diagnosis codes. Researches clinical reports for payment submission.
Additional Information:
Monday - Friday, 8:00 a.m. - 5:00 p.m. - Onsite
Required Education:
High school diploma or general education degree (GED)
Recommended Education:
Bachelors Degree or Equivalent Experience
Required Work Experience:
Related Field - 2 years of experience
Recommended Work Experience:
Administrative Support - Direct_Epic experience
Required Certifications:
Recommended Certifications:
Description
1. Obtains pre-authorization approvals for outpatient procedures from the Surgery, Day Medicine,
Radiology, Nuclear Medicine, Genetics, Sleep lab and Heart Station departments. Performs Insurance Specialist I duties at an advanced level.
2. Obtains the correct clinical reports for payers and other authorized personnel. Denials management.
3. Determines the correct CPT/ICD-10 codes for standard procedures.
4. Pre-registers patients and referral accounts prior to date of service to ensure patient eligibility, benefits and accurate claims payment. Training and education.
5. Conducts appropriate follow-ups on all assigned accounts including documenting detailed insurance information.
6. Ensures pre-certifications, pre-notifications, prior authorizations or referrals are received for each account.
7. Processes basic denial requests-Peer-to-Peer, reconsideration.
8. Obtains prior authorizations for Medicaid patients scheduled for surgery admit or outpatient surgery.
9. Performs other duties as assigned.