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Exemption Status:

Non-Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8:00am to 4:30pm (negotiable)

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

34000 - 2202 Surgical ASG

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Obtains authorization numbers from insurance companies for all testing, imaging and surgical procedures ordered within the Administrative Services Group (ASG) and schedules testing and imaging appointments once authorization is obtained

• Maior Responsibilities:

•  Completes prior authorization process for all testing, imaging and surgical procedures ordered within the ASG; schedules testing and imaging appointments once authorization is obtained. Completes regular audits and resolves issues.
  •    Works with multiple insurance carriers/vendors and keeps current with any and all changes as they relate to prior authorization.
  •    Communicates / interacts with specific divisions in the ASG regarding approved or denied prior authorizations. Communicates with Insurance Verification, the Central Billing Office and other Departments in order to resolve prior authorization issues.
  •    Manages the daily "Missing Prior Authorization" report received from Insurance Verification.
  •    Coordinates process for authorization using defined best practices; specifically internet applications.
  •    Participates in the management of a shared internet site which holds all prior authorization numbers and makes edits as needed.
  •    Assists in the maintenance of the Prior Authorization Best Practices manual which includes prior authorization requirement changes made by the insurance carriers and makes recommendations for changes.
  •    Performs weekly prior authorization audit to ensure accurate billing and resolves issues that arise.
  •    Produces correspondence, reports, memos, etc. from dictation drafts, models, etc. as required.
  •    Sets up and maintains confidential, sensitive files and records for multiple functions, academic materials, medical records, etc. ensuring efficient retrieval of information. Coordinates retrieval of medical records.
  •    Ensures adequate inventory of office supplies and basic maintenance of office equipment.
  •    Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
  •    Ensures compliance with health and satiety requirements and with regulatory agencies such as DPH, etc.
  •    Complies with established departmental policies, procedures, and objectives.
  •    Attends variety of meetings, conferences, and seminars as required or directed.
  •    Demonstrates use of quality improvement in daily operations.
  •    Complies with all health and safety regulations and requirements.
  •    Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

  Standard Staffing Level Responsibilities:
  1.    Complies with established departmental policies, procedures and objectives.
  2.    Attends variety of meetings, conferences, seminars as required or directed.
  3.    Demonstrates use of Quality Improvement in daily operations.
  4.    Complies with all health and safety regulations and requirements.
  5.    Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
  6.    Maintains, regular, reliabl