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Pre Authorization Rep

Chattanooga Heart Institute Chattanooga, Tennessee
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Requisition ID 2022-225873 Employment Type Full Time Department Cardiology Clinic Hours/Pay Period 80 Shift Day Weekly Schedule Monday - Friday Remote No Category Billing and Scheduling
Overview

The Chattanooga Heart Institute offers the most comprehensive cardiac care available in this region.  Founded in 1976, we now have six offices in Tennessee and one in Georgia.  Our practice is made up of 29 board-certified cardiologists, three cardiothoracic surgeons and three vascular surgeons.  We merged with CHI Memorial Health Care System in 2011 which is part of CommonSpirit Health.  CommonSpirit has more than 700 care sites across the U.S. and is committed to building healthy communities.


Responsibilities

Job Summary:

Responsible for insuring the necessary pre-authorizations are obtained to receive proper reimbursement for scheduled cardiac imaging performed.  Each case is evaluated individually to determine the appropriate pre-authorization requirement based on established criteria.

Essential Responsibilities:

  • Responsible for obtaining all pre-authorizations for planned outpatient cardiac imaging ordered by Chattanooga Heart Institute providers throughout the practice.
  • Interact with coding staff to ensure that medical necessity requirements are met.
  • Ensure timely updates of payer coverage.
  • Maintain vendor and payer worksheets for all cardiac imaging modalities.
  • Track and reconcile pre-authorization denials for process improvement.
  • Notify Manager/Director of documentation improvement opportunities.
  • Utilize payer website to obtain pre-authorization electronically or via phone call per company guidelines.
  • Interact with physicians and assist with peer to peer calls.
  • Provide timely and accurate feedback to Manager-Revenue Cycle should pre-authorization issues arise.
  • Provide timely and accurate pre-authorization approval information to the hospital prior to patients' appointments.

Qualifications

Education:

  • High school diploma or equivalent.

Qualifications:

  • Two years' experience with pre-authorization and/or referrals.

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.