VA Auditing Specialist

Position Summary

A VA Auth/Referral and Auditing Specialist is responsible for verifying patient insurance coverage, obtaining necessary prior authorizations for medical services from insurance companies, by reviewing medical records and determining if requested procedures are covered based on policy guidelines, ultimately ensuring timely access to care for patients while managing the financial aspects of their treatment. While auditing for accuracy and validity of all authorizations or referrals for VA and Tricare. The VA Auth/Referral and Auditing Specialist will be overlooking authorizations and referral within departments such as: LCRP, Patient Accounts, Pre-Service and Registration.

Education

High School Diploma - Preferred

Experience

1-3 Years Insurance experience - Required

2-3 Years Medical background - Preferred

License & Certification

None Required

Core Job Functions

Demonstrates responsibility in maintaining patient records in organized and secure manner. Ensures HIPAA regulations are continuously followed.

Determines precertification necessity. Communicates and coordinates with insurance companies to maximize reimbursement. Communicates with other departments to eliminate denials from insurance companies.

Monitor various reports for precertification need. Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.

Documents within EMR and hospital charting system data on precertification and payer correspondence. Ensures appropriate referral information is taken by the front desk staff to limit denial of services

Accurately measures and records the type, frequency, and responsibility for missing or inaccurate authorizations, navigation or any other insurance benefit related issue that causes delays in the patient treatment schedule.