The specialist serves as a liaison between patients and clinical staff, managing complex scheduling, appointment coordination, and patient inquiries. They are also responsible for handling prior authorizations, insurance verification, and reconciling daily financial transactions.
The specialist performs thorough medical record reviews to identify and assign accurate ICD-CM and ICD-10 PCS codes for inpatient facility coding. They also provide clinical documentation improvement support and ensure compliance with official coding guidelines and hospital policies.
The Prior Authorization Rep II is responsible for verifying insurance eligibility, calculating patient estimates, and securing prior authorizations for complex medical services. They act as a liaison between payers, medical staff, and providers to resolve authorization issues and ensure financial security for the organization.
This position is responsible for abstracting, coding, and interpreting outpatient clinic and provider services for billing purposes. The role also involves serving as a resource for coding staff, resolving complex billing issues, and educating personnel on regulatory guidelines.
The Nurse Specialist improves the quality and completeness of clinical documentation by educating physicians and staff on documentation standards. They facilitate modifications to medical records to ensure accurate reflection of patient status, clinical treatment, and appropriate reimbursement.
The role involves negotiating provider contracts and conducting reimbursement analyses to determine financial impacts. The executive serves as a liaison between the health plan and provider organizations to maintain effective professional relationships.
