Patient Access Services Authorization Representative Remote

About the role

This position performs insurance verification and authorization functions that support Patient Access Services and ensures compliance with both department standards and billing requirements. The role requires the ability to retain large amounts of changing payor information crucial to attaining reimbursement for services provided and is expected to reduce authorization-related initial denials/write-offs.

Responsibilities

• Accurately complete authorization initiation requests with payers for all service lines and validate existing authorizations requested by providers using department procedures and new hire training.
• Complete authorization initiation for acute and ambulatory visits.
• Utilize standard authorization submission tools, websites, and document authorization updates in Host systems.
• Provide necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing.
• Provide information about the referral process to physician and staff.
• Document and maintain records of all referral activity and authorizations in appropriate Host fields.
• Refer encounters for peer review to substantiate ordered procedures.
• Respond to “provider orders” for tests, procedures, and specialty visits.
• Obtain authorizations for single and/or reoccurring visits required by various payers, including verification of patient demographic information, codes, dates of service, and clinical data.
• Stay current on payor requirements and utilization of third-party authorization submission software to complete authorizations.
• Work independently from a remote location and follow structured work routines.
• Work in a fast-paced environment requiring independent decision making and sound judgment to prioritize work and ensure appropriateness and timeliness of each patient’s care.
• Follow escalation protocols for accounts not meeting authorization standards by working with the ordering provider, scheduling departments, PAS leaders, and administrative groups for resolution in all acute, ambulatory, Banner Imaging, and Oncology service lines.
• Perform other related duties as assigned, which may include cross-coverage in other authorization-related areas.

Requirements

• High school diploma/GED is required.
• Minimum of three years of experience in healthcare insurance and/or authorizations.
• Business skills and experience in the assigned work area are required.
• Detail oriented with the ability to maintain high productivity standards with minimal errors.
• Advanced abilities in the use of common office software, word processing, spreadsheet, and database software are required.
• Ability to manage multiple tasks simultaneously with minimal supervision and to work independently.
• Excellent organizational skills, human relations, and communication skills required.

Preferred Qualifications

• Associate’s degree in Business Management or equivalent preferred.
• Certification in CRCR and/or CHAA preferred.
• Additional related education and/or experience preferred.

Skills

• Healthcare insurance authorizations (Imaging, Surgery, Pharmacy, or other procedures).
• Health insurance experience.
• Customer service skills.
• Problem-solving skills.
• Basic knowledge of CPT and ICD Codes.
• Reliable internet with Ethernet connection only.
• Ability to work in a quiet work area/home office.

Schedule

• Monday – Friday, 8:00 AM to 5:30 PM Mountain Standard Time or Arizona Time.

Pay

• Estimated pay range: $20.01 – $30.01 per hour.