Clinical Data Abstractor

Job Purpose

A Precertification Coordinator is responsible for obtaining prior authorizations and referrals on behalf of the provider’s office for Cardiac Cath, Cardiac EP,for Outpatient and Inpatient procedures,

Job Duties and Responsibilities

• Prioritize incoming authorization and referral requests according to queue urgency
• Review patient’s clinical and chart documentation related to the service submitted by the provider’s office
• Obtain and/or follow up on authorization and referral requests from the patient’s payer/s through any of the following methods—depending on the payer’s policy:

o Perform outbound calls to payer’s authorization department o Access payer’s authorization online portal o Submit faxes to payer’s authorization department

• Respond to payer’s clinical questions to be able to proceed with the authorization and referral requests
• Obtain and/or follow up payer’s peer-to-peer review requirements and send them back to provider’s office for the actual initiation
• Cater inbound calls from payers and perform necessary actions required for the task
• Listen and review voicemail messages from payers then perform necessary actions required for the task

Required Skills

• Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes
• Comprehensive understanding of Medical Terminology
• Prior experience in processing multispecialty authorizations including contact with payers
• Experience in medical coding specially for Cardiac procedures
• Experience with general computer software (Internet, Word, Outlook, PDF required)
• Proficiency to learn new software programs quickly
• Excellent customer service skills: communicates clearly and effectively
• Excellent verbal and written communication skills
• Professional and effective interaction skills with co-workers, clients, providers, and vendors
• Proven ability to work well individually and as a team member
• Strong attention to detail
• Ability to follow company and account-specific standard operating procedures and policies
• Ability to adapt to constantly changing environment
• Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand
• Ability to remain organized with multiple interruptions
• Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies
• Ability to comfortably receive constructive feedback

Qualifications

• Must hold a valid PHRN license
• Willing to work onsite in Ortigas
• At least 1 year of experience in any of the following:
• 1–2 years of experience in business process outsourcing
• PHRN with prior authorization experience
• Oncology Data Specialist (ODS)/NCRA Certification Required