*PATIENT CONNECTION AUTHORIZATION ASSOCIATE RN, PRN/DAYS, (REMOTE), PIEDMONT HEALTHCARE

Description

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 service being performed. Liaisons with physicians and physician office staff including peer to peer when needed to obtain additional demographic, insurance or clinical information. Provides clinical support to Patient Connection Center Authorization and Prep Associates or as needed.

KEY RESPONSIBILITIES:
1. Initiate a Peer to Peer with the Medical Director of the respective Payer, in order to provide supporting information that may obtain an authorization.
2. Uses benefits and order information on file to initiate and secure pre-authorizations in advance of the day of care.
3. Communicates with physicians, patients, and payers to secure and/or provide missing demographic, insurance, and/or clinical information to authorize service(s).
4. Documents all payer communications thoroughly, and communicated payer decisions in a timely manner.
5. Communicates with clinical staff and revenue cycle leadership.
6. Complies with HIPAA regulation and procedures at all times.
7. Handles oneself in a professional and courteous manner representing Piedmont when working with internal staff, patients, and payer representatives.

KNOWLEDGE, SKILLS, ABILITIES
• Familiarity with National Coverage Determinations and Local Coverage Determinations.
• Proficient in medical terminology and able to interpret patient medical records.
• Knowledge of medical necessity screening criteria (e.g., Milliman, InterQual).
• Ability to identify procedure and diagnosis discrepancies.
• Strong time management and prioritization skills.
• Excellent communication (verbal and written) customer service with patients, staff, and Payers.
• Strong attention to detail.
• Skill and ability to handle multiple priorities and deadlines.
• Ability to work as a member of a team.
• Skill and ability in Microsoft Office applications.