CharlottesvilleRecruiter Since 2001
the smart solution for Charlottesville jobs

Referral/Pre-Authorization Specialist

Company: University of Virginia
Location: Charlottesville
Posted on: October 8, 2019

Job Description:

Job location: Harrisonburg, VA Employment Type: Full-time Posted data: 2019-08-06 Req: R0009075 The incumbent is responsible for timely, accurate and comprehensive review of patient schedules. Coordinates and effectively communicates with appropriate personnel regarding insurance carriers, PFS, and UPG to ensure quality patient care and appropriate reimbursement. The incumbent also obtains the appropriate Pre-Authorization and Referral information, including verification of patient insurance, from physicians and insurance carriers. Reviews patient schedules to ensure that the appropriate Pre Auth/Referral numbers are approved for Radiology visits. Communicates with referring and/or ordering physician to obtain medical necessity and clinical data for procedure(s), including demographics needed to verify patients' insurance company in a timely and organized manner. Communicates with patients regarding insurance eligibility, benefits, other preauthorization and referral requirements; and delivers information to patient and staff in a supportive, timely and understandable manner. Contacts insurance carriers by phone and/or automated systems to verify patient insurance and procedure to be performed, including eligibility and in/out of network. Obtains pre-authorizations/referrals on outside physicians, verifies eligibility/benefits with patient insurance carrier by phone, fax, or on-line, and provides timely follow up with insurance carriers to obtain preauthorization/referral documentation for outpatient services. Communicates with medical center staff and physicians before patient visit regarding verification of primary care physician, special instructions, insurance denials, obtaining a waiver, or rescheduling patient. Communicates with Radiology billing staff in a timely manner to ensure accurate preauthorization information is aligned with accurate billing services. Identifies trends/problems in medical documentation and provide possible solutions, including reports as requested. Obtains medical necessity for "V" codes to ensure reimbursement for hospital and physician payment. Liaison for the PCAD Department , UVA clinics and outside physician office(s), provide CPT-4, ICD-10, clinical indications, also provide patient eligibility, billing, preauthorization, referral, and CPT/ICD-9 issues. This is done daily for all Radiology patients. Assigns appropriate CPT-4 procedure code(s) to accurately report the physician services provided to patients. Also, assigns appropriate ICD-10 codes to accurately identify patients clinical indications for exam scheduled. Collects medical data and input data in the correct order into the PET Registry system based on Medicare and CMS requirements and guidelines to ensure timely reimbursement. Once confirmation has been received, coordinates with referring physician to submit the pre-post PET data requirements. Ensures daily metrics are obtained to ensure peer-to-peer compliance with preauthorization/referral requirements and quality assurance, which is closely monitored and reported to the Billing Manager for review and analysis. Enters or transfers Pre Auth/Referral data in a timely and accurate manner to appropriate fields in A2K3 and the Radiology's database system. Conducts daily research on Pre Auth/Referral numbers of Physicians Group (UPG) departmental requests and return them within three days of initial receipt from UPG. Researches monthly denial reports looking for Pre Auth/Cert/Referral information. Must indicate appropriate information found and resubmit it for reimbursement. Analyzes and resolves physician claim rejects and denials from the billing system or insurance carriers related to coding issues to ensure reimbursement. Reviews medical record documentation to identify all services provided by physicians. Participates in process improvement activities and provide training to faculty and staff regarding compliance issues. Assists with the submission of billing data to UPG. Ensures that TES work files do not exceed more than two weeks from the date of service at any given time. Accurately enters (keys) Pre Auth/Referral information in the appropriate fields in the TES encounters, to release the charges to IDX, and ensure reimbursement of services. Ensures the appropriate CPT & ICD10 code has been entered according to approved prior Authorization/referral. Performs other duties as assigned. MINIMUM REQUIREMENTS Education: High School Diploma or GED Experience: Two years of related experience, including some working knowledge and experience in pre-authorizations and referrals. Licensure: None Skills: Familiarity with personal computer operations. Basic word processing and spreadsheet software skills required. Demonstrated knowledge and expertise in the use of the reporting system to prepare reports as requested a plus. Demonstrated independent judgment and knowledge of insurance company criteria for outpatient diagnostic testing and processes. PHYSICAL DEMANDS This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require walking some distance to attend meetings, and programs. The University of Virginia, including the UVA Health System and the University Physician's Group are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

Keywords: University of Virginia, Charlottesville , Referral/Pre-Authorization Specialist, Other , Charlottesville, Virginia

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Benefit Rep
Description: The Largest Healthcare Benefits Discount Company is seeking Representatives that want to work from home.
Company: Living Healthy
Location: Chantilly
Posted on: 10/19/2019

Automotive Service Technician
Description: Description The Automotive Service Technician I ASTI is responsible for performing basic automotive services in compliance with TBC Corporation s policies, procedures, and quality standards as (more...)
Company: NTB
Location: Charlottesville
Posted on: 10/19/2019

CDL-A TRUCK DRIVERS - GREAT PAY AND HOMETIME!
Description: CDL-A Van and Flatbed Company Driver Jobs Pay and Home Time you can count on --If you are looking to drive for a company where you receive excellent
Company: LST Services
Location: Charlottesville
Posted on: 10/19/2019


Sales Associate
Description: Description In the automotive Sales Associate role Customer Service Advisor you ll have a great opportunity to learn the auto services business. This role is responsible for selling tires, (more...)
Company: NTB
Location: Charlottesville
Posted on: 10/19/2019

Hirschbach CDL A Driver
Description: Hirschbach Company Driver Job. Dedicated Routes. Guaranteed Minimum Pay of 1,150 to 1,250 Per Week Company Driver Benefits:--- Late-model equipment - 2016-2019 trucks---
Company: Hirschbach Motor Lines
Location: Chantilly
Posted on: 10/19/2019

Get New Contractor Work Today - Preview Leads In Your Area
Description: Over 25 million homeowners have trusted HomeAdvisor 1800Contractor to help them find quality professionals with the expertise to turn their home improvement
Company: HomeAdvisor
Location: Charlottesville
Posted on: 10/19/2019

Cloud Developer - Chantilly
Description: Technology is constantly changing, and our adversaries are digitally going dark at a rate that is exceeding law enforcement's ability to keep pace. Those charged with protecting the United States are (more...)
Company: Peraton
Location: Chantilly
Posted on: 10/19/2019

CDL Class A Solo Static Lane Run from Louisville, KY to Memphis, TN - NO TOUCH
Description: br br CDL Class A Solo Static Lane Run from Louisville, KY area to Memphis, TN area NO TOUCH br CDL Class A Solo Static Lane Run - NO TOUCH br Contact a Recruiter 855 385-7415 br or br (more...)
Company: Summitt Trucking
Location: Charlottesville
Posted on: 10/19/2019

Glazier
Description: SUMMARY: Install all types and sizes of glass, including plate glass, safety glass, insulated glass of all kinds and thicknesses into windows, storefronts, curtain walls, etc. as required. Cut glass to (more...)
Company: Glass & Metals, Inc.
Location: Harrisonburg
Posted on: 10/19/2019

Store Associate
Description: Support and maintain the integrity of the Vera Bradley experience through exceptional customer service, upholding store image standards, maximizing sales and assisting in store operational needs. br (more...)
Company: Vera Bradley Designs Inc.
Location: Leesburg
Posted on: 10/19/2019

Log In or Create An Account

Get the latest Virginia jobs by following @recnetVA on Twitter!

Charlottesville RSS job feeds