Full-Time Authorization & Eligibility Representative

About the Role

Ashe Memorial Hospital is seeking a team member to join a recognized healthcare organization in a close-knit mountain community. This position focuses on insurance authorization coordination, ensuring that all necessary authorizations are obtained prior to patient exams, and providing cost estimates and scheduling support to patients and referring offices.

Responsibilities

• Utilizes work list to contact appropriate utilization management company or insurance payer to request authorization where company can obtain
• Sends timely requests to referring physicians for authorization numbers where company cannot obtain
• Communicates authorization cases denied for medical necessity or requiring peer to peer review to the referring physician for resolution
• Validates all authorizations for accuracy prior to exam
• Follows up on all pending authorizations with the appropriate entity
• Forwards correspondence to offices for exams on their daily schedule
• Documents authorization in scheduling system according to defined protocol
• Answers incoming calls from offices, referring physicians and patients regarding authorization requirements and status
• Answers incoming calls from patients to provide an estimate of out of pocket cost after insurance processing prior to exam
• Arranges appropriate date/time based on patient needs and exam being scheduled when patient calling for price quote elects to have procedure performed
• Responsible for contacting patients directly to reschedule the exam if authorization is not obtained prior to appointment time
• Executes eligibility searches using available applications
• Researches eligibility exceptions to locate missing information or determine if there is an absence of coverage
• Provides excellent customer service with all customers
• Adheres to referring physician requested protocol regarding authorization requests

Qualifications

• High school diploma or GED
• 1+ year healthcare experience preferred; insurance authorization experience a plus
• Strong communication and organizational skills
• Fully vaccinated for COVID-19 and other required immunizations