Loudoun Medical Group (LMG), one of the largest and most diverse physician-owned, multi-specialty group practices in Virginia, is seeking and experienced Prior Authorization Representative to support a busy Sleep Center office in Leesburg, Virginia.
- Maintains, confirms and secures referrals, authorization, or pre-certifications required for patients to receive physician services, medical procedures and medication.
- Verifies the accuracy and completeness of patient account information.
- Maintains database of payer authorization requirements.
- Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems.
- Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.
- Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
- Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance. Notifies ordering providers if authorization/certification is denied.
- May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
- Maintains files for referral and insurance information, and enters referrals into the system.
- Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
Knowledge, Skills & Abilities
- Knowledge of third-party payers and pre-authorization requirements.
- Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / pre-certification / authorization processes.
- Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, physician practice management, and electronic medical records systems.
- Strong analytical, prioritization and organizational skills.
- Ability to work independently with minimal supervision and to manage multiple priorities.
- Exceptional communication and interpersonal skills with a high degree of diplomacy and tact.
- Ability to effectively communicate with a variety of people under stressful circumstances.
Loudoun Medical Group provides competitive compensation and benefits including employer sponsored health, dental, vision, life, long-term disability, 401(k) and profit sharing. This is a great opportunity to work for a growing healthcare organization that employs over 200 medical providers throughout 23 medical and surgical specialties in over 100 clinical locations from Berryville to Alexandria.