Insurance Authorization Representative

-Schedule: Hybrid M-F 7:30am-4pm (flexible days and hours)

Education/Training:

High School Diploma or Equivalency

Licenses/Certification:

• N/A

Education/Training

• High School Diploma or Equivalency

Licenses/Certification:

• N/A

Required Qualifications and Skills:

• Minimum of 1-3 years of experience in a healthcare related field.

• Interpersonal skills to effectively interact with patients, physician offices, insurance companies and departments throughout the hospital.

• Discipline and professionalism to work independently and within a team structure.

• Ability to complete time sensitive tasks within guidelines.

• Ability to use various software and office equipment.

Preferred Qualifications and Skills:

• Previous experience obtaining prior authorizations in a hospital setting.

• Third party knowledge

• Business office experience

• Medical terminology/knowledge

• Cerner experience.

• Familiarity with verifying insurance coverage and allowable benefits

• Critical thinking skills.

• Detail oriented.

Essential Job Functions:

• Obtain precertification/ authorization for inpatient and observation patients presenting through the Emergency Department.

• Run payer eligibility, review self-pay and refer to Financial Counselors as applicable.

• Review surgical and endoscopic cases for accuracy and completion.

• Run daily reports as required.

• Compliance with HIPAA.

• Call payers and/or electronically obtain prior authorization for departments within the hospital.

• Work with outside offices to ensure they are obtaining Prior Authorization.

• Work closely with case management department to ensure clinicals have been sent to the payer.

• Call payers for follow-up on prior authorization status.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Age and Diversity Related Criteria:

Consistently treats patients, colleagues, and visitors with dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics, and cultures.

Ability to Fulfill Job Expectations:

Must have the ability to perform the essential functions of the position, including required work hours, locations, and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the workplace, and with or without reasonable accommodation.

Physical Demands:

Ability to sit for prolonged periods of time. Sit while working at computers. Use hands to manage, control, or feel objects, tools, or controls. Repeat the same motions. See details of objects that are less than a few feet away. Speak clearly so listeners can understand. Understand the speech of another person. Must be able to lift up to 15 pounds at times.

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Salary Range Details

The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value Sturdy Health’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.

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Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.