Prior Authorization Representative
Prior Authorization Representative
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Job Description
Overview:
PA Representative will be responsible for prior authorizations for comprehensive pain services administrative support of pain team providers and integration within Anesthesiology & Pain Management administrative team. Administrative support duties include completion of reimbursement requests meeting coordination day to day office support and special projects as assigned.
Job Description Summary:
Job Description:
Essential Functions:
- Participates in pre-authorization documentation process obtaining compiling maintaining and issuing necessary records reports ensuring accuracy of content and correct distribution. Documents pre-authorization information appropriately in the hospital information system (HIS).
- Contacts third party payer to obtain pre-authorization for ordered exam providing updates as needed throughout the pre-authorization process.
- Reviews pending pre-authorizations and provides follow up if needed.
- Communicates to clinics when peer to peer is requested and reviews clinic progress on pre-authorizations that require additional detail for approval.
- Provides additional information requested by Patient Accounts to assist in billing issues involving pre-authorization.
Education Requirement:
- High School Diploma or equivalent required.
- Associates Degree preferred.
Skills:
- Excellent customer service and communication skills.
- Ability to work and problem solve with minimal supervision.
- Ability to understand and retain complex and quickly changing information.
- Knowledge of the impact of the revenue cycle on hospital operations.
- Familiarity with medical terminology.
- Ability to function as a team member responsible for staffing operational hours.
- Ability to adapt to change positively in workflow and process.
- Keyboarding typing or data entry skills.
Experience:
- One year of pre-registration registration admitting or customer service experience preferred.
- One year of experience in billing processes and insurance verification preferred.
- Working knowledge of HIS Work Queues.
Physical Requirements:
OCCASIONALLY: Decision Making Standing Walking
FREQUENTLY: Interpreting Data
CONTINUOUSLY: Audible speech Computer skills Flexing/extending of neck Hand use: grasping gripping turning Hearing acuity Peripheral vision Problem solving Repetitive hand/arm use Seeing Far/near Sitting
The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified nor is it intended to limit or modify the right of any supervisor to assign direct and control the work of employees under their supervision. EOE M/F/Disability/Vet
Required Experience:
Unclear Seniority
Employment Type
Full-Time
