Authorization Representative

Description

SCHEDULE: Full-time; 36 hours per week; 4 days per week; Monday, Tuesday, Thursday, Friday; 7:00 am - 4:30 pm

Responsible for maintaining referral and authorization records, obtaining authorizations, scheduling visits and ensures all visits are linked to referrals as required by insurance companies and the electronic health record. Assists with "on the fly" authorizations for services that are changed at time of service. Contacts patients for updated insurance information, where applicable and coordinates with the financial advocates when needed for all patients, including self-pay or out of network estimates. Prepares reports of activity as requested by management. Performs financial reviews and calculations based upon information received from the insurance company, assists with logistical and/or clerical problem resolution related to the patient's medical record, authorization and billing issues.

Requirements

High school diploma or equivalent required. Associates degree in finance or medical office assistant or CMA, LPN or RN preferred. Two years of related healthcare Revenue Cycle experience, preferably within billing and/or coding or clinical experience. Understanding of medical terminology and clinical documentation. Clear understanding of the impact insurance verification and prior authorization have on Revenue Cycle operations and financial performance. Demonstrated knowledge of insurance carriers' guidelines and criteria of verification, authorization and reimbursement, as well as website navigation. Understanding of coding (CPT, ICD10, HCPCS). Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers. Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment. Ability to prioritize and effectively anticipate and respond to issues as they arise. A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Word, Excel) as necessary; general computer skills necessary to work effectively in an office environment.