Pre Authorization Rep

CHI St. Vincent a regional health network serving Arkansas is part of CommonSpirit Health. We have served Arkansas since 1888 with a history of many firsts. Together with more than 4500 coworkers 1000 medical staff and 500 volunteers we consistently receive praise for care advancements. CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. CHI St. Vincent provides you with the same level of care you provide to others. We care about our team member well-being and offer benefits that complement and support your work/life balance.

As a Pre-Authorization Representative you will be responsible for ensuring a smooth and efficient pre-admission and pre-authorization process for all patients safeguarding necessary financial clearance before services are rendered.

Daily you will accurately gather and verify patient demographic and insurance information obtain necessary pre-certifications and authorizations from insurance companies and communicate financial responsibilities to patients. You will serve as a key point of contact coordinating with physicians offices insurance providers and hospital departments to facilitate seamless patient access to care. Your work directly contributes to preventing claim denials and ensuring financial integrity.

Success in this role requires meticulous attention to detail strong knowledge of insurance practices and medical terminology excellent communication skills and a commitment to patient advocacy and financial accuracy.

• Responsible for obtaining all pre-authorizations for procedures scheduled through clinic.
• Utilize payer website to obtain precertification electronically.
• Review electronic order to ensure precert cpt matches what is ordered by the physician.
• Interact with schedulers and notify them when peer to peer calls are necessary.
• Interact with coding or clinical staff to ensure that medical necessity requirements are met.
• Stay up to date on insurance policy and criteria that must be met

• High School Graduate or GED upon hire
• 1 year experience with pre-certification at a medical clinic/facility preferred