Accurately and efficiently identifies all appropriate and necessary clinical documentation to support medical necessity for all scheduled procedures/medication orders for multiple service lines and clinics.
Submits authorizations and clinical information to the appropriate payer/benefit manager in a timely fashion in compliance with plan rules including appropriately utilizing the CMS IP Only list.
Assesses orders to determine appropriate patient class and works with physicians to clarify as necessary
Contacts insurance plan/payers to determine eligibility, coverage information for specific procedures and benefit information
Coordinates patient encounters using multiple systems applications, various registration applications, clinical operating systems, eligibility verification systems and medical necessity applications.
Documents all findings/communications thoroughly and accurately in the patient record.
Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
Documents all authorization information accurately in the referral as necessary to produce a clean transaction with the payer.