Authorization Representative
Role Overview
Obtains authorization from payers for any procedure or service requiring prior authorization. Notifies Nurse Navigator of authorization requirements as discovered from payers. Creates list of authorization methods - phone or web-based. Creates payer listing, contact information, requirements. Assists with identifying departmental procedures and authorization requirements. Identifies and communicates with providers when authorization requirements change. New payer plan review, evaluation and research of authorization requirements alongside Nurse Navigator. Assists financial advocates with calculation of estimates for services and communication with patient. Provides authorization assistance to department staff when the procedure performed is different from the procedure authorized. Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral and Insurance Verification requirements and processes. Communicates efficiently, effectively and timely to resolve issues pertaining to the verification and authorization processes. Schedules visits: Infusion Center, Surgical Clinic, Surgery and other hospital services areas as determined. Note: this is a partial listing of key job areas. For a complete job description, contact HR.
Key Skills for This Role
Full Job Posting
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.
Summary
Obtains authorization from payers for any procedure or service requiring prior authorization. Notifies Nurse Navigator of authorization requirements as discovered from payers. Creates list of authorization methods - phone or web-based. Creates payer listing, contact information, requirements. Assists with identifying departmental procedures and authorization requirements. Identifies and communicates with providers when authorization requirements change. New payer plan review, evaluation and research of authorization requirements alongside Nurse Navigator. Assists financial advocates with calculation of estimates for services and communication with patient. Provides authorization assistance to department staff when the procedure performed is different from the procedure authorized. Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral and Insurance Verification requirements and processes. Communicates efficiently, effectively and timely to resolve issues pertaining to the verification and authorization processes. Schedules visits: Infusion Center, Surgical Clinic, Surgery and other hospital services areas as determined. Note: this is a partial listing of key job areas. For a complete job description, contact HR.
About Myrtue Medical Center
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