Patient Authorization Representative II

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Job Summary

Patient Authorization Representative is responsible for verifying insurance eligibility and ensuring all authorizations for pre certifications, inpatient and out- patient exams/ test are received.

Reports to: Manager, assigned department

Job Specific Responsibilities

Daily assignments may include but are not limited to:

• Verify insurance eligibility and benefits
• Obtain and update patient benefits, identifying limitations and/or exclusions for each particular plan as it pertains to the patient’s care
• Coordinate physician and/or facility referrals and pre certifications for patient appointments
• Perform office administrative duties such as scheduling, processing POs/invoices, scanning, faxing, answering and routing phone calls, etc..
• Communicate with other hospital departments, insurance companies, and at times, patient’s family members to ensure continuity of care for reoccurring appointments, financial responsibility, and to ensure facility receives maximum reimbursement for services provided
• Collect payments, establish payment arrangements, discuss payment options
• Inpatient, Observation and Surgical management of authorization/ referrals and clinical processes.
• Submit timely authorization and referrals using CPT, diagnosis and procedure codes.
• Submit authorization on IPSNF, IPREHAB and IPLTC to ensure expedited patient discharges.
• All other related assigned duties

**Cancer Center Patient Authorization Representatives work with Financial Aid Office for screening determination of patient’s ability to pay

Education and Experience

• High School Diploma or GED
• +3 years of experience working with insurance verifications and pre certifications, preferably in a hospital setting
• +3 years use of medical terminology and preferred knowledge CPT codes, procedure codes and DRG’s classifications.

Required Licensures/Certifications/Registrations

N/A

Skills and Abilities

• Excellent customer service skills; Must speak, read, and write English fluently
• Ability to multi- task, handle problems, interruptions, and other stressful situations in a professional manner.
• Demonstrate planning, organizational and ability to follow-through until a process is complete.

Interaction with Other Departments and Other Relationships

Interacts with patients, family members, and other hospital departments

Physical Capabilities

Work involves sitting most of the time, but frequently involves walking or standing for brief periods of time. This position requires constant phone use. Talking and hearing is essential for communicating with physicians, coworkers, patients, insurance carriers, etc…

Environmental/Working Conditions

This position is subject to indoor and outdoor environmental changes that may include varying temperatures.

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

*Request for accommodations in the hire process should be directed to UMC Human Resources.*