Clinical Authorizations Representative

Responsible for accurately and efficiently capturing all assigned provider’s diagnostic studies ordered, verifying insurance, and obtaining authorizations for any diagnostic studies while meeting and exhibiting standards of excellence in customer service.

Pay

$18.50 - $20.50 per hour

Qualifications

• High School Diploma or GED is required.
• Previous customer service experience required.
• 1-2 years’ experience in a medical environment with experience in medical insurance verification and pre-authorizations.
• Must be proficient in Microsoft Office applications, including Outlook, Excel, and Word.
• Effective written and oral communication, critical thinking and problem solving skills required.
• Knowledge of medical terminology and diagnostic studies.

Responsibilities

• Communicates with patients over the phone in a professional and customer service oriented manner.
• Communicates effectively with staff, secretaries, and physicians by phone, in person or in writing.
• Captures the diagnostic study record for assigned clinic and becomes the record owner.
• Verifies benefit coverage, eligibility for diagnostic study owned in Filemaker prior to testing date.
• Ensures assigned diagnostic study records are completed in a timely manner.
• Determines whether the patient’s insurance company required pre-authorization and obtains all authorizations, if applicable.
• Able to identify the difference when a prior authorization or a referral is needed prior to the diagnostic studies being performed.
• Identifies, reviews, extracts, and provides clinical notes, durations and response to conservative treatment measures from patient’s visits to the insurance carrier in an effort to obtain a secure pre-authorization for the diagnostic studies.
• Ensures the nature and outcome of the contact with the insurance carrier of each diagnostic test request is documented in Filemaker, Athena to support claims billing and reimbursement of the diagnostic studies.
• Establishes a good working relationship with Primary Care Physicians’ offices, Insurance and various diagnostic testing facilities and hospitals.
• Maintains a thorough understanding of all major insurance carrier benefit verification and authorization processes.
• Keeps current with updates for various health plans.
• Maintains and utilizes online access to major insurance carriers.
• Seeks clarification of physician’s diagnostic study orders, if necessary.
• Communicates with the patient on the process of their authorization.
• All other duties as assigned.

Benefits

• Full time opportunities available, with room for career growth and advancement.
• Excellent job stability to promote an optimal work life balance.
• Drug-free workplace; pre-employment drug screening and random drug testing required.