Prior Authorization Representative

Job description

Starting hourly rate of $16.75 an hour plus commensurate with experience Work Shift: Day Scheduled Weekly Hours: 40 Summary: This position supports Mercy's philosophy of patient centered care by possessing a complete understanding of health insurance industry requirements for preauthorization to ensure medical necessity and appropriateness of delivery of health care resources provided to members as per their benefit package. Responsible for initiating an accurate and complete preauthorization, making required edits on pre-authorizations and initiating follow up as needed. Job Description: Job Duties: - Performs pre-authorization duties requiring good knowledge of hospital programs and procedures. - Possesses a complete understanding of health insurance industry requirement for preauthorization per payer. - Initiates an accurate and complete pre-authorization and makes required edits on pre-authorizations as needed. Includes following up on missing pre-authorization information. - Understands ICD-10 coding systems for local medical review policies (LMRP), national coverage determination (NCD) and pre-authorization process required. - Interacts frequently with physicians, physician o...