Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations.• Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list• Route to appropriate staff when needed• Verify eligibility and benefits• Answer phone queues and process faxes within established standards• Data enters authorizations into the system.• Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.• Corrected Errors in our cloud system that did not cross over into our system to get them to cross over and processed.

Coordinating and monitoring the overall movement of patients through the continuum of care in a safe and efficient manner and serving as a liaison with physicians to ensure that appropriate care can be delivered• Works in conjunction with the transfer coordinators and/or House Supervisors to manage completion of registration and status changes for ER and procedural admissions, intra-hospital transfers• Responsible for facilitating an efficient, professional and effective registration process through the attainment of demographic and financial information that is pertinent to appropriate reimbursement and statistical analysis for all direct admits from the Medical Faculty Associates and from outside hospitals or clinics• The individual is responsible for maintaining complete and accurate accounts to ensure database integrity and timely claims processing• The individual will be a part of an organizational culture that provides the highest degree of service excellence standards to all customer groups• Works in conjunction with the transfer coordinators and/or House Supervisors to manage all aspects of registration for all outside hospital transfers, rehab admissions, inpatient voluntary psychiatric admissions and direct admissions from providers offices, based on medical needs and bed availability• Additional duties may include pre-registration and registers patients presenting at the hospital for inpatient, outpatient and emergency services.• Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.• Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.

Responsible for reviewing accessions for tests requiring prior authorization from the insurance company, coordinating with clients and insurance carriers to obtain prior authorizations as needed per coverage• Provides accurate and timely information to supporting CPL departments, clients, patients, and the Accounts Receivable (AR) department• Adheres to departmental policies and procedures to include timely submission and follow-up on pending requests as well as notification of status to appropriate AR department• Obtaining clinicals to submit authorization to insurance companies• Faxing clinicals and information needed to insurance companies• Reaching out to clients and patients informing of denial of authorization or approvals, if denied seeing if the patients still wants to proceed with test and be billed for the test by paying up front, billed or workout a payment arrangement.• Input all patient data regarding claims and prior authorizations into system accurately.• Analyzed medical records and other documents to determine approval of requests for authorization.