About The Role

Responsible for accurate prior authorization and billing process. Maintains related documents, updates corresponding records and responsible for enrollment and billing queries. Collaborate with the billing service function to support electronic and technical operations. Handles complex enrollment or billing issues and reports to the manager with the relevant updates. Candidate will be responsible for coding vascular services, obtaining insurance pre-certifications, prior authorizations, and referrals for office visits, medical procedures, diagnostic testing and specialty services.

Principal Accountabilities

Authorization Initiation - Obtaining necessary documentation, submitting requests and following up on pending requests and tracking their status.
Review Medical Records- Analyze patient medical records, including diagnosis, treatments and procedures, to support authorization request.
Communicating with insurance providers, requesting additional information, handling denials and addressing any issues related to authorization, denials or delays.
Review and analyze denial letters, coordinate peer to peer reviews with physicians, prepare appeals and work to secure final authorization.
Maintaining accurate records of prior authorizations requests, approvals, denials, and peer to peer reviews.
Documenting all authorization requests, approvals and denials in patients’ records (Referral- communications)
Confirm the patients’ insurance policy covers proposed procedure.
Ensure compliance with payer policies and procedures to avoid denials.
Document all communication and authorization details in EPIC.
Communicate authorization status (denial-delays) to patients or medical staff.
Obtain referrals from outside providers when needed.
Assist billers with insurance appeals should a claim deny.
Actively maintain current knowledge of insurance guidelines and pre-certification requirements.
Answer billing- insurance questions for department team members.
Assist patients with inquiries or complaints.
Review and assign procedure and diagnostic codes for vascular surgery clinicians. To include hospital surgeries, consultations, progress notes and IR procedures.
Monitoring office visit work queue to forecast charge entry volume.
Review clinical office notes for vascular surgeons, to ensure documentation supports assigned CPT code.
Reconcile appointment sessions using EPIC and Scheduling to confirm all charges completed.
Assist billing team with inquiries as needed.

Required

High School Diploma or equivalent.

Preferred

Experience with insurance verification, referral processes, and prior authorizations.
Experience with Medicare, Medicaid, and commercial insurance.
Fluency in CPT and ICD-10 Coding and medical billing.
Knowledge of healthcare billing and reimbursement including industry standard billing rules.
Excellent verbal and written communication skills
Strong Organization Skills
Working knowledge of medical terminology and anatomy.
Proficiency in Microsoft Office, Exchange, and electronic billing system