Prior Authorization Representative I
Prior Authorization Representative I
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
This position is responsible to secure outpatient accounts by performing insurance verification obtaining benefit information calculating patient estimates and obtaining prior authorization before services are rendered. This position works with physicians nurses clinic managers and financial advocates to resolve issues that arise during the prior authorizations process. This position is not responsible for providing care to patients. This position is eligible for work from home and/or hybrid work options. Might be required to work onsite during training period.
Responsibilities
Essential Functions Verifies insurance eligibility benefits network status and creates preservice liability estimate. Ensures accurate ICD CPT codes and related medical records are submitted in the authorization request. Secures prior authorizations for outpatient imaging and in office scheduled services. Acts as a liaison between the payer and clinic schedulers/medical support staff. Follows up on delayed or denied authorization requests and escalates for resolution. Creates detailed documentation and maintains/stores the authorization paper trail. May work to resolve claims denials related to the prior authorization. Knowledge / Skills / Abilities Basic knowledge of accounting word processing and spreadsheets. Demonstrated critical thinking and ability to analyze information and problem solve. Demonstrated professional verbal/written communication skills. Ability to work independently within a team setting. Ability to adapt to a dynamic work environment. Demonstrated ability to prioritize and manage a large workload in stressful situations. Ability to multitask. Familiarity with human anatomy and medical terminology. Demonstrated ability to complete work with a high level of detail and accuracy. Ability to meet process time standards. Ability to provide professional and courteous service in all interactions with internal and external customers. Ability to navigate through various hospital software applications including Epic ADT /Prelude Cadence Epicare Referrals and Auth/Cert applications. Ability to navigate and maneuver through multiple web sites.
Minimum Qualifications
Required Two years of experience in a health care financial setting or equivalency (one year of education can be substituted for two years of related work experience). Preferred Previous experience with medical insurance and priorauthorizations. ICD / CPT coding experience. Outpatient or Radiology prior authorizations experience.
Required Experience:
Unclear Seniority
Employment Type
Full Time
