Outpatient Administrative Rep - Funding Services

Location: Hybrid, in office once a week/remote after 6 months. Salary range: $18.65 - $26.86/hour, depending on experience.

About the role

The Administrative Representative position is responsible for insurance authorization and verification, ensuring all insurance-related information is accurately documented. This role tracks authorizations for medical procedures, medications, or specialized treatments/therapies, follows up on pending or denied authorizations, and collaborates with clinical/therapy teams to submit required medical documentation. Detailed insurance benefits-related data is maintained in the EPIC/electronic health records system.

Requirements

• High school diploma or equivalency (required)
• 1-3 years front desk experience in a clinical environment (required)
• Previous experience with medical terminology, charge entry, EPIC software, Medicare/Medicaid, and commercial insurance (preferred)
• No licensure, certification, or registrations required

Skills & Abilities

• Excellent team-building, conflict resolution, and communication skills (verbal and written)
• Ability to organize and prioritize multiple tasks effectively
• Professionalism under pressure, including managing a multi-line telephone system
• Ability to work with frequent interruptions and complete assignments in a timely manner
• Collaborative approach with departments and physicians
• Strong computer skills with Microsoft applications (preferred)
• Spanish-speaking ability (preferred)

Responsibilities

• Verify eligibility by checking insurance portals and contacting insurance companies to confirm patient enrollment, active benefits, and cost responsibilities
• Secure and track prior authorizations for medical procedures, medications, or specialized treatments/therapies
• Resolve issues by following up on pending or denied authorizations and submitting required medical documentation with clinical/therapy teams
• Accurately document detailed insurance benefits, approval numbers, and expiration dates in the electronic health record (EHR) system and tracking program
• Perform other related duties as assigned

Benefits

Craig Hospital offers a wide range of benefits to tailor a package that meets individual needs:

• Self-funded medical insurance administered by Allegiance Benefit Plans with a CIGNA network, offering two comprehensive plans
• Dental insurance through Delta Dental
• Vision insurance through EyeMed
• Health Care and Dependent Care Spending Accounts
• Paid Short Term and Long Term Disability Insurance for all benefit-eligible employees
• Generous time-off benefits
• 403b Retirement Plan with a generous matching contribution through Empower Retirement (eligible upon hire)
• Tuition Assistance for continuing education
• Employee Assistance Programs and an Employee Emergency Assistance Fund