Prior authorization representative vs patient access representative

Differences between prior authorization representative and patient access representative duties and responsibilities

Prior authorization representative example responsibilities.

• Manage inbound/outbound calls for medical personnel and patients, along with computerize data entry to regulate proper distribution of prescription medication.
• Utilize knowledge of physician office policies, CPT and ICD-9 coding, procedures, and equipment.
• Provide compassion without judgment in regards to patient's finances.
• Determine if CPT and ICD-10 codes are correct and qualify for coverage.
• Review all daily EDI reports to make sure claims are being accept properly.
• Perform chart audits via EMR, prepare medical records for subpoenas, general requests.
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Patient access representative example responsibilities.

• Use EMR software to manage patient records and files; reinforce and uphold patient confidentiality as required by HIPPA and clinic.
• Conduct intensive screening of all Medicare, Medicaid and manage care patients for provider service eligibility.
• Educate eligible applicants about Medicaid manage care and how to access benefits in a manage care environment.
• Run internal reports to ensure ICD 9 and CPT procedure codes are accurate for billing for Medicare and Medicaid patients.
• Deliver quality customer service and compassion while obtaining demographic and financial data from patients seeking emergency medical services.
• Operate front desk check-in, preparation of charts, receive payments and balance books at the end of the day.
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