Posting ID : A1068495360
Date Posted : 2015-08-19
Category : Healthcare
Northwest Orthopaedic & Sports Medicine, a division of Proliance Surgeons, located in Richland, WA is seeking to fill a Full-Time Preauthorization L&I Coordinator position.
Position Summary: This position is responsible for a combination of the L&I Coordinator's and Preauthorization Coordinator's job functions. The Preauthorization L&I Coordinator will contact insurance companies to confirm benefits coverage, and obtain insurance authorization for all surgeries and advanced imaging procedures performed and/or ordered by NOSM physicians and practitioners. The incumbent will provide L&I support and answer all L&I related questions. In addition, this position will manage all L&I related communications, including distributing appropriate forms and documentation for the company between all third parties and the injured workers.
1.Obtain prior authorizations on surgical procedures and advanced imaging procedures as required.
2.Communicate authorizations, or lack thereof, to the appropriate MA, and/or physician and surgery scheduler.
3.Verify insurance eligibility with the patient's insurance company.
4.Check for pre-existing wait periods and if needed discus with patients.
5.Provide L&I support to and answer any questions of physicians, MA-C's and other co-workers.
6.Obtain authorizations from claims managers for surgeries, MRI's, EMG's and consults.
7.Handle all L&I related phone calls, voice mails, emails, and messages from injured workers, claims managers, VOC counselors, and employers.
8.Submit new claim forms, reopening's, and APF's. Bill form fees and scan documents.
9.Respond to and/or distribute all L&I faxes including Job Analysis's (JA), Independent Medical Evaluation's (IME), progress reports, bill form fees and scan documents to the appropriate physicians.
10.Respond to and distribute all incoming L&I mail such as, allowances, orders, forms and closures.
11.Communicate with adjudicators as needed for protests and ratings.
12.Demonstrate prioritization of responsibilities in order to effectively meet deadlines and schedules.
13.Communicate effectively and share necessary knowledge with employees, administrator, and physicians.
14.Maintain effective public relations with both physicians and patients utilizing tact, courtesy and diplomacy.
15.Must follow facility's policies, procedures, and management plans. Most importantly maintaining patient and facility confidentiality at all times.
16.Continue to enhance self-education on different insurance company plans and systems.
17.Exhibit a positive, professional demeanor to peers, patients, physicians, and visitors, even under stressful circumstances.
18.Able to effectively work with and around people of all ages, nationalities, and creeds.
19.Promote team image and possess a high degree of flexibility, including being willing to fill in for personnel as needed.
20.Responsible for own professional development and improvement. Strive for self-improvement.
21.Possess ability to follow directions quickly and efficiently with varying workloads and interruptions.
22.Use equipment properly, reporting malfunctions, problems and follow-up appropriately.
23.Exhibit accountability, recognize limitations and seek help as needed.
24.Maintain safe and organized working area.
25.Perform other related duties as assigned for the purpose of ensuring the efficient and effective functioning of the surgery center.
ESSENTIAL SKILLS AND EXPERIENCE
1.Graduate from high school or completion of GED.
2.Must have at least two years of college education with emphasis in the medical field, or two years' experience in the medical field OR a combination of both.
3.One year experience with pre-authorizations and referrals.
4.Excellent customer service, interpersonal and communication skills.
5.Must be skilled in medical terminology with a comprehensive knowledge of surgical procedures, including ICD-9 and CPT coding.
6.Possess strong computer skills and mathematical skills.
7.Possess ability to function effectively under stressful situations.
8.Possess ability to solve problems, resolve errors, make corrections and improvements and make decisions in a logical, reasonable manner.
9.Accept instruction and constructive criticism. Demonstrate ability to adapt accordingly.
To apply please email your cover letter and resume to . Salary DOE.