Insurance Authorization Representative

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$20.40/hr - $30.60/hr

• Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems.
• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.
• Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
• Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
• Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.
• May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
• Maintains files for referral and insurance information, and enters referrals into the system.
• Maintains knowledge of and reference materials of the following:
  Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.

• None Required.

• High School Graduate.

• Typically requires 1 year of experience in providing customer service that includes experiences in patient accounts, third‑party payer plans, accounts receivable/collection processes, and medical clinic processes and workflow.

• Knowledge of third‑party payers and pre‑authorization requirements.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / pre‑certification / authorization processes.
• Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, physician practice management, and electronic medical records systems.
• Strong analytical, prioritization and organizational skills.
• Ability to work independently with minimal supervision and to manage multiple priorities.
• Exceptional communication and interpersonal skills with a high degree of diplomacy and tact. Ability to effectively communicate with a variety of people under stressful circumstances.

• Exposed to a normal medical office environment.
• Sits the majority of the workday.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Not Applicable

Part‑time

Other

Hospitals and Health Care

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