Southern Illinois Healthcare PRIOR AUTHORIZATION REP in Carbondale, Illinois
Responsible for patient prior authorization, patient referrals including scheduling of internal referral and outgoing patient referrals, documentation of status of prior authorizations and referrals, ability to navigate registration, referral entries, auth/cert entries and patient chart workflows in EPIC, ability to update and confirm current patient insurance coverage and day to day monitoring of all EPIC prior authorizations and referrals work queues.
Manages processes effectively in regard to employee/patient safety.
Maintains all required records, reports, statistics, logs, files and other documents as required, including but not limited to payroll, schedules and status changes.
Promotes a culture of process improvement by participating in unit/department based programs that supports the system’s process improvement goals.
Actively participates on system-wide or hospital-based teams as needed.
Role Specific Responsibilities
Monitors EPIC prior authorization and referrals work queues daily
Classified insurance approvals, based on physician orders, in order to expedite claim processing.
Identify and prioritize urgent and emergency prior authorizations and referral consultation requests
Checks chart for relevant referral/prior authorization information and shares with appropriate insurance provider or referring office provider
Call or submit online request to insurance providers for prior authorizations
Communicates details regarding denials and peer-to-peer request for prior authorizations and provider offices
Communicates effectively with patients, provider staff and insurance providers by telephone and Epic Inbasket
Follow through on referrals and prior authorizations to completion/resolution in a timely fashion
Document progress/status of prior authorizations and referrals on the EPIC referral or EPIC auth/cert forms
Follow-up on missing insurance documentation with patients
Schedules internal referrals in EPIC directly onto the provider’s schedule.
Validates information for a prior authorization or referral request and follows-up with providers office regarding missing CPT codes or missing chart documentation
Collaborates with staff to identify workflow problems and identify solutions
Consistently looks for ways to streamline the prior authorization and referrals process an improve the patient and staff experience
Leads, tracks, monitors updates in insurance prior authorization criteria and educate provider staff
High School Diploma or Equivalent.
Posting Job Title: PRIOR AUTHORIZATION REP
Requisition ID: 2021-6777
External Company Name: Southern Illinois Healthcare
External Company URL: https://www.sih.net/
Street: 1239 East Main
Weekend Requirement: Weekends as required
Name: Prior Authorization-SIMS Admin