Pre-Authorization and Medical Records Clerk
Overview:
St. John's Riverside Hospital is a leader in providing the highest quality, compassionate health care utilizing the latest, state-of-the-art medical technology. Serving the Westchester community from Yonkers to the river town communities of Hastings-on-Hudson, Ardsley, Dobbs Ferry and Irvington, St.John's Riverside has been and continues to be a unique and comprehensive network of medical professionals dedicated to a tradition of service that spans generations.
St. John’s has been an integral part of the community since the 1890's and its’ commitment to provide the community with the most advanced medical services available continues to be the hospitals’ vision, mission and value. St. John's Riverside Hospital built itself around an early foundation of nursing and community service.In 1894, the Cochran School of Nursing, the oldest hospital-based school of nursing in the metropolitan area, was founded, thus making the St. John's Nursing Staff more than just the backbone of the hospital, but the heart and soul. St. John’s dedicated nurses give superior attention to those who need it most with a strong emphasis on patient and family-focused nursing care.
St. John’s Riverside Hospital staff is committed to making life better for all patients. The hospital continues to elevate the services provided with the goal of increasing the quality of life for all who entrust St. John's Riverside Hospital to their care.
Personalized care together with advanced technology is what it means to be Community Strong
Responsibilities:
The Pre-Authorization/Medical Records Clerk will complete pre-auths as needed for Providers in the SJMG to ensure timely and accurate approval of patient care visits/procedures. In addition, the Clerk will assist with management of medical records requests.
Obtain prior authorization as assigned in a timely matter, but not limited. Ensure insurance is re-verification and properly updated in the system. Communicate outcome of pre-auth requests to SJMG Senior Director and/or Coordinator of Revenue.When appropriate, conduct appeals, and facilitate peer reviews with the physician. Review patient account files and ensure accuracy and timely submission of all documents. Identifies problems/concems related to pre-auths and reports same to Senior Director and/or Coordinator of Revenue.
Pursues all concems/discrepancies in a timely manner to ensure pre-auths are completed. Prioritize workload and develops system to track prior authorizations requiring follow up. Required to scan and maintain all follow up documentation in the patient's account file.
Ensure proper documentation is retrieved and sent for required bitling and reviews, monitors any medical record request from Medicare or insurance carriers for timely submission. Knowledgeable in billing practices including standard codes sets (HCPCS, CPTS & ICD-9 coding, UB 04 & 1500 forms, 837 and 835 requirements).
Maintain current working knowledge of Medicare and Medicaid. Assists in special projects and other duties as assigned.
Qualifications:
High School Diploma or equivalent. Minimum of 2 years of relevant experience. Proficient in Microsoft office. Spanish speaking perfered.