PC Authorization Associate II,PRN

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