Job Description
At Ivinson Memorial Hospital we are committed to excellence, trust, healing, and integrity. We pride ourselves in providing compassionate, world-class care to our community. At Ivinson we offer a competitive total rewards package including; full medical, dental, and vision insurance, retirement plans, paid time off and tuition reimbursement opportunities. Ivinson aims to improve the care provided for our patients and create a work-life balance for our employees by creating a culture of transparency, teamwork, accountability, and trust. Base salary starts at $17.30/hr . E S S E N T I A L F U N C T I O N S Compiles and communicates accurate and pertinent clinical data and demographics to the patient’s insurance company. Keeps current on insurance regulations to obtain and record patient data; and maintain knowledge of system requirements. Follow-up with insurance carriers to obtain certification/authorization numbers for outpatient services. Performs on-line data entry of certification/authorization or denials and pre-authorization status. Facilitates resolution of pre-authorization or referral issues for scheduled patients and same day add-ons to insure payment from the insurance company on the patient’s behalf. Works closely with Utilization Review to ensure all notifications, prior authorizations and continued stay reviews are completed as needed. Coordinates with Social Worker when needed. Ensures that all prior authorizations and ongoing authorizations documentation, databases, and records are maintained clearly and accurately, within a timely manner and meet HIPPAA requirements. Coordinates peer to peer reviews with providers for denied requests. Perform clinical reviews of authorization requests using appropriate criteria. Serves as a resource for staff, APP’s and physicians regarding prior authorizatio