GENERAL SUMMARY: The Insurance Authorization Representative will work as a liaison with Hospital Authorization departments to obtain insurance verification, notification, pre-certification, authorization, and obtaining reference numbers (as appropriate) for all patients undergoing surgical procedures, endoscopic procedures, testing, and infusions within the hospital as well as clinic settings. This individual must possess basic clinical knowledge and terminology and must be able to effectively communicate with and support multiple doctors/specialists, APPs, and team members. The role requires the ability to work in a fast-paced, changing environment, identify problems, and communicate with the members of the Revenue Cycle team (Coders, Patient Account Reps, Coding and AR Supervisors) and insurance companies in a timely manner.
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES: Obtain and/or work with Hospital Departments to obtain authorizations in a timely manner for endoscopic procedures, surgical procedures, radiology and laboratory testing, infusions, and visits within the hospital and clinic setting. Review the insurance verification and complete the authorization process within established time frames. Accurately enter data into the software program. Receive coverage authorization and work diligently to meet established timelines; may be required to obtain authorizations for same-day procedures. Work closely with doctors, APPs, and team members to support efforts to accomplish authorization/verification for both routine and STAT orders. Routinely arrange and oversee peer-to-peer authorizations between specialists and insurance companies. Request authorization from insurance company/Hospital Department to provide specific services and parameters of care. Serve as a liaison between the clinic and specific areas of the hospital to assure timely authorization and provision of services. Provide effective communication to patients/families, team members, and other healthcare professionals while maintaining confidentiality. Assist in correcting claim denials. Provide assistance to patients in understanding their financial responsibility and guide them through the process. Adhere to all company policies and procedures. Obtain necessary demographic, diagnostic, and insurance information. Obtain clinical information required to request prior authorizations. Provide backup to all front office positions; check-in, check-out, and medical records. KNOWLEDGE AND SKILLS REQUIRED: Demonstrated effective communication and interpersonal relation skills. Demonstrated computer experience using word processing and data entry software. Must be able to type 30 wpm and know 10-key by touch. Strong organizational skills. Ability to adhere to strict timelines. Multi-tasking skills. Proficiency in EMR and EPM. Previous insurance verification experience. Proficiency in medical terminology. Previous customer service work experience. Problem-solving skills and attention to detail. Knowledge of ICD-10 and CPT coding. Knowledge of payer requirements for authorization and billing. EDUCATION AND EXPERIENCE REQUIRED: High School diploma or equivalent. 3-5 years of Insurance Verification Experience plus 1-2 years of Authorization experience. This facility is an equal opportunity employer and complies with federal, state, and local anti-discrimination laws, regulations, and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience, and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.
Category: Patient Financial Services
Organization: AdventHealth Medical Group West FL
Schedule: Full-time
Shift: 1 - Day
Req ID: 24030040
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age, or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits, and other terms and conditions of employment.
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