GENERAL SUMMARY:

Insurance Authorization Representative will work as a liaison with Hospital Authorization departments to obtain insurance verification, notification, pre-certification, authorization and obtaining reference numbers (as appropriate) for all patients undergoing surgical procedures, endoscopic procedures, testing and infusions within the hospital as well as clinic setting. Insurance Authorization Representative will work closely with all members of the physicians’ teams to assure timely and accurate authorization for both routine and stat items.  This individual must possess basic clinical knowledge and terminology and must be able to effectively communicate with and support multiple doctors/specialists, APPs and team members.  This individual must be able to work in a fast pace, changing environment. This individual must also be able to identify problems and communicate with the members of the Revenue Cycle team (Coders, Patient Account Reps, Coding and AR Supervisors) and insurance companies in a timely manner. 

 

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

·       Obtains and/or works with Hospital Departments to obtain authorizations in a timely manner for endoscopic procedures, surgical procedures, radiology and laboratory testing, infusions and visits within the hospital and clinic setting. 

·       Reviews the insurance verification and completes the authorization process within established time frames. Accurately enters data into software program.

·       Receives coverage authorization and works diligently to meet established timelines; may be required to obtain authorizations for same day procedures.

·       Works closely with doctors, APPs and team members to support efforts to accomplish authorization/verification for both routine and STAT orders.

·       Routinely arrange and oversee peer to peer authorizations between specialists and insurance companies.

·       Requests authorization from insurance company/Hospital Department to provide specific services and parameters of care. 

·       Serves as liaison between clinic and specific areas of hospital to assure timely authorization and provision of services.

·       Provides effective communication to patient/family, team members, and other health care professionals and maintains confidentiality.

·       Assist in correcting claim denials.

·       Provide assistance to patients in understanding their financial responsibility and walking the patients through the process.

·       Adhere to all company policies and procedures.

·       Obtains necessary demographic, diagnostic and insurance information.

·       Obtains clinical information required to request prior authorizations

·       Provides back up to all front office positions; check in, check out, and medical records

Qualifications

KNOWLEDGE AND SKILLS REQUIRED:

·       Demonstrated effective communication and interpersonal relation skills

·       Demonstrated computer experience using word processing and data entry software

·       Must be able to type 30 wpm and know 10-key by touch

·       Strong Organizational Skills

·       Ability to adhere to strict timelines

·       Multi-tasking skills

·       Proficiency in EMR and EPM

·       Previous insurance verification experience

·       Proficiency in Medical Terminology

·       Previous customer service work experience

·       Problem Solving Skills and Attention to Detail

·       Knowledge of ICD-10 and CPT coding

·       Knowledge of payer requirements for authorization and billing

EDUCATION AND EXPERIENCE REQUIRED:

·       High School diploma or equivalent

·       3-5 years of Insurance Verification Experience plus 1-2 years of Authorization experience.

 

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

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