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Pre-Authorization Specialist

Location:  Fairfax, VA

Status:  Full-Time/Non-Exempt

 

  • No Evenings
  • No Nights
  • No Weekends
  • No Major Holidays

Virginia Heart is Northern Virginia's premier cardiovascular practice, bringing an unparalleled standard of excellence to our patients. We are seeking experienced professionals to join our team in our outpatient cardiology setting.  Every employee, at every level, begins their journey at Virginia Heart learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it. 

We offer great benefits! 

  • Comprehensive benefits package with low premiums (Medical, dental and vision) 
  • Life insurance of 50K covered by Virginia Heart, with option to purchase additional
  • 401K pension plan based on profit and a percentage of salary 
  • Paid Short Term Disability with optional long-term insurance available for purchase 
  • Employee assistance program for mental and physical well-being
  • Up to 28 days paid time off, with accrual of 1 additional vacation day per year through year 10
  • Annual merit-based increases
  • Employee Appreciation Events, includes therapy dogs, raffles, other fun rewards
  • Career Advancement Opportunities
  • Employee Referral Bonus
  • Semi-annual employee surveys
  • Employee Discount Programs
  • Flexible spending accounts, pretax dollars for health and dependent care 
  • Employee Committee Opportunities (e.g., Diversity/ Inclusion, Employee Advisory Committee)
  • No nights, no weekends, no holidays and no on-calls!
  • Set shifts and schedules 

The Pre-Authorization Specialist obtains Pre-Authorizations for patient procedures and provides support to the office manager, physicians, billing, clinical staff, referring physicians and most importantly, the patient.  The Pre-Authorization Specialist must have a high level of accuracy and precision in work.  The Pre-Authorization Specialist must exude an attitude of teamwork and provides superior customer service to meet co-worker and patient needs in a manner consistent with Virginia Heart’s mission of excellence in cardiovascular care.  

RESPONSIBILITIES:

  • Manages all aspects of obtaining Pre-Authorization prior to patient procedures (in office, hospital procedures, external imaging).
  • Works as a team within the department, with other Virginia Heart epartments (Patient Services, Billing, Hospital Scheduling, Office Managers, and physicians), and referring offices.
  • Requests medical records within Virginia Heart, from referring offices, and surrounding hospitals
  • Contacts insurance companies via phone and insurance web based systems.
  • Verifies patients insurance and relay proper CPT codes/Diagnosis codes to insurance companies for Pre-Authorization approval and/or referrals.
  • Identifies all accepted insurance plans and cards.
  • Checks insurance eligibility; obtains patient insurance referrals as needed. Is able to interpret and use Virginia Heart’s demographic charts.
  • Acts as a liaison between insurance companies, Virginia Heart physicians, and patients (peer-to-peer process).
  • Responsible for answering phones in a courteous, professional, and timely manner.
  • Provides friendly and efficient telephone services to patients and Virginia Heart staff and transfers calls as appropriate.
  • Demonstrates professionalism in all interactions with patients, vendors and fellow employees to create a positive experience.
  • Exudes confidence on the telephone fostering reassurance for our patients.
  • Resolves issues appropriate to position.

REQUIREMENTS:

  • HS Diploma or equivalent required

     

  • CPT and ICD-10 CM coding criteria and guidelines preferred (preferably in cardiology)
  • Proficient in Microsoft Excel and Word required
  • EPIC experience preferred
  • Minimum of 1 year experince in customer service related field, preferably a fast paced environment
  • Knowledge of insurance carriers, carrier websites, coverage policies and benefits
  • Ability to read EOB and explain definition of out of pocket, deductible, and co-insurance  

(Click link to view other available openings and locations for our company: https://virginiaheart.hiringplatform.com/list/careers)