Overview
About Us
Lifepoint Health’s Central Kentucky market is comprised of four acute care, community-based hospitals, with over 50 outpatient clinics that provide comprehensive healthcare in the Bluegrass region.Bluegrass Community Hospital(Versailles, KY),Bourbon Community Hospital(Paris, KY),Clark Regional Medical Center(Winchester, KY), andGeorgetown Community Hospital(Georgetown, KY) are committed to our mission of making communities healthier. As an integrated network, our facilities have the ability and resources to develop opportunities for professional growth and advancement to accomplish your career goals. We take pride in personalized patient care backed by high-quality designations to support a culture of safety for both employees and patients. Get back to the heart of your community by caring for your neighbors — join our team today!
A Career with Us Offers:
· Newly Adjusted Competitive Pay Rates
· Paid Time Off (PTO)
· Extended Illness Benefit (EIB)
· Flexible Spending Accounts (FSA)
· Choice of Insurance Plans (Health, Dental, Vision, Life)
· Educational Assistance
· Bereavement Leave
· 401(k) Match
· Free Parking
GENERAL RESPONSIBILITIES Initiate and resolve prior authorization and other case-related concerns prior to a patient’s procedure or diagnostic test. Will obtain authorization via payer website or by phone and follow up regularly on pending cases. Review chart documentation to ensure patient meets medical policy guidelines Prioritize incoming authorization requests according to urgency Maintain schedule of procedures for providers and staff’s viewing purposes Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations Initiate appeals for denied authorizations including requesting peer to peer reviews and coordinating with MD Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order Contact patients to discuss authorization status Respond to calls, faxes and telephone encounter queries by patients and outside parties regarding PAs Ensures patients have been cleared for specialty service office visits. Obtains referrals from primary care physicians. Relays pertinent messages from hospitals and directs team to reschedule procedures at facility where benefits are accepted. Assist billing department/Central scheduling to obtain retro referrals for services that were rendered. Perform insurance eligibility verification or update of insurance registration information as applicable Review daily schedules to verify that visits have been through pre-authorization process. Any new additions to the procedure schedule will require coordination of benefits and follow up with the respective department. Review fax inbox for newly scheduled procedure and conduct insurance verification and obtain proper authorizations. Other duties as assignedSPECIFIC ADDITIONAL DUTIES Covering clinic when other nurse is out while handling STAT PAs or emergency retro PAs Takes initiative to assist in clinic when Prior authorization volume is low Checking the fax inbox for job-related items Requesting records from outside facilities or practices as needed by provider Handling P2P hospital records that need to be allocated in chart Assisting clinic nurse with telephone encounters and referrals when clinic is busy as requested by clinic nurse Retrieving and returning messages from clinic voicemail when clinic nurse is out
Job Requirements
Minimum Education 2 years medical prior authorization experience preferred Previous EMR/EHR experience Knowledge of health insurance concepts (i.e., Medicare, Medicaid, MCR Advantage Plans, HMO, PPO, etc.). Proficient computer skills. Exceptional customer service skills. Proficient and accurate data entry skills. Ability to multi-task, prioritize work as needed based on urgency and turnaround time. Ability to make sound judgments. Ability to remain patient during long periods of telephonic hold times. Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company. Prolonged sitting. Repetitive motion (data entry), and phone contact.
Required Skills Excellent customer service skills; communicates clearly and effectively as part of a team; Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle Understanding of payer medical policy guidelines in order to manage authorizations effectively Basic understanding of human anatomy, specifically cardiovascular system Proficient use of CPT and ICD-10 codes Excellent computer skills including Excel, Word, and Web applications Detail oriented with above average organizational skills Plans and prioritizes to meet deadlines Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
**Job:** **Physician Services*
**Organization:** **Clark Regional Physicians Practices*
**Title:** *Pre-Auth Specialist (Digestive Care Clinic)*
**Location:** *Kentucky-Winchester*
**Requisition ID:** *7424-6195*
