Pre-Access Authorization Consumer Access Specialist

AdventHealth Gordon; Calhoun (GA); On-site; USD 22,000 - 35,000; Full time

Benefits offered by this job

Benefits from Day One

Paid Time Off from Day One

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Pet Benefits

Job summary

AdventHealth in Calhoun, GA is seeking a staff member to obtain prior authorization and pre-certification for services, ensuring medical necessity criteria are met. You will coordinate with the clinical team to align payer guidelines and support documentation processes.

The role involves documenting authorizations in EMR, communicating with physician offices, and verifying patient eligibility. A High School Diploma or GED is required to perform duties in a fast-paced healthcare setting.

Qualifications

• Validation is required.
• High school grad or equivalent required.
• GED acceptable as alternative.

Responsibilities

• Obtains prior authorization or pre-certification of services for payment by insurance companies.
• Submits clinical documentation for approval to payors and ensures medical necessity criteria are met.
• Acts as liaison with the clinical care team to ensure payer guidelines compliance.
• Distributes information to ancillary departments and verifies eligibility and benefits as needed.
• Documents prior authorization information in EMR and communicates with physician offices regarding status.

Skills

Validation

Education

High School Grad or Equiv

GED

Job description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

1035 RED BUD RD NE

City:

CALHOUN

State:

Georgia

Postal Code:

30701

Job Description:

• Obtains prior authorization or pre-certification of services for payment by insurance companies, including CMS and state programs.
• Submits clinical documentation for approval to payors and ensures medical necessity criteria are met.
• Acts as a liaison with the clinical care team to ensure compliance with payer guidelines.
• Participates in clinical performance improvement initiatives related to documentation and quality utilization.
• Coordinates communication between business and clinical operations. Distributes information to ancillary departments and verifies eligibility and benefits as needed.
• Accurately documents prior authorization information in EMR and other systems. Communicates with physician offices regarding the status of requests.
• Ensures all scheduled testing meets Medicare medical necessity standards. Obtains patient demographic and insurance information from new patients and enters it into the computer.
• Treats patients and their families with respect and dignity while ensuring confidentiality of patients’ records.
• Provides information about patient rights and HIPAA.
• Other duties as assigned.

Knowledge, Skills, and Abilities:

• Validation [Required]

Education:

• High School Grad or Equiv [Required]

Field of Study:

• or GED

Physical Requirements: (Please click the link below to view work requirements)

• Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$16.05 - $25.67

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.