Prior Authorization/Medical Coder Job Description:
Cy-Pain & Spine PLLC are looking to recruit a competent Prior Authorization/Medical Coder Specialist to be responsible for all aspects of the prior authorization process and assist us with coding medical documentation for insurance claims and for our databases. Responsibilities include collecting all the necessary documentation, contacting the client for additional information and completion of the required prior authorization in order to proceed with testing. Complete, timely, and accurate identification and submission of prior and retro authorization requests to the payors. Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations. The Specialist will also assign required Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and American Society of Anesthesiologists (ASA) codes. You will assign Ambulatory Payment Classifications (APC) or Diagnosis-related group (DRG) codes.
To ensure success you need to make judicious decisions on which codes to assign in each instance, and function to a high level of accuracy. Top applicants are motivated, detail-oriented and have outstanding people skills.
Prior Authorization Responsibilities:
- Performs daily activities of billing and auditing of accounts to ensure accurate claims submissions and to optimize reimbursement for patient treatment from clients, commercial/government payers and patients.
- Document eligibility, benefit and authorization information in accordance with established guidelines.
- Research patient accounts due to invalid and/or missing authorization information and correspond with clients, insurance companies, patients, sales representatives to obtain the necessary information to ensure accurate, timely and complete claims submissions.
- Verify prior authorizations and/or pre-service requirements are met.
- Proactively manages and maintains all outstanding authorization accounts to increase billing of clean claims.
- Provide outstanding customer service to patients and develop and maintain positive working relationships with internal and other external customers.
- Identify and report trends and prior authorization issues relating to billing and reimbursement.
- Document all account activity and correspond to inquires in a timely manner.
- Reviews accounts on a daily basis while meeting or exceeding all daily, weekly and monthly production goals.
- Communicates and works effectively with colleagues from other departments.
- Follows written and verbal communications.
- Performs other related duties as required or assigned.
Medical Coder Responsibilities:
- Extracting relevant information from patient records.
- Liaising with physicians and other parties to clarify information.
- Examining documents for missing information.
- Assigning CPT, HCPCS, ICD-10-CM and ASA codes.
- Assigning APC and DRG codes.
- Ensuring documents are grammatically correct and free from typing errors.
- Performing chart audits.
- Advising and training physicians and staff on medical coding.
- Informing supervisor of issues with equipment and computer program.
- Ensuring compliance with medical coding policies and guidelines.
- High School Diploma, GED, or suitable equivalent.
- 2+ years work experience as Prior Authorization/Medical Coder.
- American Academy of Professional Coders (AAPC) or Medical billing certification a plus.
- Proficient computer skills.
- Excellent communication skills, both verbal and written.
- Strong people skills.
- Outstanding organizational skills.
- Ability to maintain confidentiality of information.
Monday through Friday 8 AM to 5 PM