Prior authorization representative vs patient care coordinator

Differences between prior authorization representative and patient care coordinator 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 care coordinator example responsibilities.

• Communicate with insurance companies on a continuous basis to ensure hospital reimbursement and attain authorization for home and rehabilitation services.
• Manage caseload by providing care coordination to individuals with a primary intellectual/developmental disability diagnosis all of whom receive community-base waiver services.
• Check in, check out patients, and do EKG's.
• Gain knowledge relate to bundle payments for orthopedic patients and the rules and regulations set forth by CMS.
• Respond to telephone inquiries, providing quality service to customers, PSR's and insurance representatives inquiring about patient accounts.
• Prepare patients prior to MRI exam, obtain safety check lists and assist with the daily operations of the MRI department.
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