Authorization Representative - Adult Urology Surgery Clinic

Authorization Representative - Adult Urology Surgery Clinic Job Description

The Authorization Rep ensures patients have been cleared for Hospital services, specialty service and office visits. Resolves pre-certification, registration and case-related concerns and determination of patient finanical obligation prior to a patient's service or visit. Works with insurance carriers, financial counselors, specialists and other ancillary staff. Also responsible for accurately validating patient information and ensuring the patient's experience is best in class.

Relies on guidelines to accomplish tasks. Relies on experience and judgment to complete job. Works under general supervision.

• Gathers information from the chart and clinic personnel regarding insurance coverage and reason for the procedure.
• Relays authorization approval, peer-to-peer request or denial status to clinic personnel and physicians in a timely manner to facilitate patient care.
• Accurately and efficiently processes referrals to specialists, hospitals and diagnostic centers in accordance with physician orders, ensuring timely processing for required services; coordinates referrals with insurance providers to minimize financial liability to the patient.
• Obtains and scans outside clinic records after patient appointment with specialist to assure continuity of care.
• Quality:
  Utilizes available resources to determine if physician participates with the patient's insurance plan; ensures lists of doctors and needed items are updated and modified as necessary; attends meetings and participates on committees as directed; strives to improve meeting quality by taking an active role in meeting topics.
• Assures that authorizations are obtained prior to the date of service for 99% of scheduled cases.
• Schedules are reviewed prior to the date of service to ensure authorization numbers are obtained for all procedures that require one.
• Scans authorization confirmation/denials into chart in a timely manner to facilitate claims processing if issues arise.
• Responsible for verification of insurance information, as well as documenting the need for authorization or lack of need for authorization in the computer system to facilitate claims processing.
• Contacts insurance carriers to secure authorization information; documents authorization information in the computer system to ensure visits are approved.
• Acts as a resource for department personnel relative to the authorization process and documentation required for services.
• Other Duties as Assigned:
  Performs other duties as assigned or requested.

Experience:

1 year experience in medical office or hospital setting

Education:

High School or equivalent

Special

Skills:

Basic clerical and computer skills

• Job Identification 44432
• Job Category
• Job Shift Day
• Job Function Patient Access
• Worker Type Employee
• Regular or Temporary Regular
• Requisition Schedule Full-Time
• Hours of Schedule (e.g. M-F 8a-5p) M-F 8a-5p
• Department Adult Urology Surgery-OLOLPG Urology Baton Rouge
• FMOLHS Company Code Our Lady of the Lake Physician Group LLC