Job description
JOB DESCRIPTION
TITLE
: Prior Authorization Specialist
DEPT
: CAGW
Cardiovascular Testing
JOB CODE:
03504
SCOPE OF POSITION:
This position is responsible for processing orders for cardiovascular testing ordered by Cardiology Associates of Greater Waterbury LLC. This position is responsible for processing of cardiovascular testing orders, ensuring that the order is complete, meets medical necessity, and has required authorization in place, allowing for test(s) to be scheduled by the facility in accordance with the time frame ordered.
RESPONSIBILITIES:
Review orders for completion, verify medical necessity, and determine if prior authorization is require.
Work closely with providers for order completion and clarification where necessary.
Obtain Prior Authorizations for cardiac testing. Example: Echocardiograms, Nuclear and non-nuclear, exercise and pharmacological stress testing, stress echocardiograms, and carotid ultrasound. Including; follow up of pending authorizations, initiating appeals, facilitating peer reviews, and communicating with patients.
Provide order and any necessary documents/records to testing facility.
Other Duties as assigned to meet the needs of the practice.
REQUIREMENTS:
- Graduate of Medical Office/Administrative Assistant training program preferred.
- Knowledge of Medical terminology, Insurance, ICD-10, and CPT Codes.
- Experience with AIM, NIA preferred.
- Ability to manage multiple tasks, work under pressure, and prioritize work.
- Ability to establish and maintain effective working relationship with management team, physicians, staff, patients and outside facilities.
- Must be self-disciplined and be able to function independently as well as part of a team, and use good judgement.
- EMR experience, Athena experience preferred
- Excellent interpersonal, verbal and written communication skills.
- Must be able to work in a seated position for extended periods of time.
- Must be able to accept additional responsibilities as appropriate.
THE ABOVE DESCRIPTION COVERS THE MOST SIGNIFICANT DUTIES PERFORMED BUT DOES NOT EXCLUDE OTHER OCCASIONAL WORK ASSIGNMENTS NOT MENTIONED, THE INCLUSION OF WHICH WOULD BE IN CONFORMITY WITH THE FACTOR DEGREES ASSIGNED TO THIS JOB.
Location: Waterbury Hospital ยท Cardiology Associates of Greater Waterbury
Schedule: Full Time, Days, 40 HR Days 8-430
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