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

Skills

• Healthcare insurance authorizations (Imaging, Surgery, Pharmacy, or other procedures) with 2 or more years of experience.
• Health insurance experience with 1 or more years.
• Great customer service skills and problem-solving skills.
• Basic knowledge of CPT and ICD codes.
• Reliable internet connection (Ethernet only) and a quiet work area/home office.

Schedule

Monday – Friday, 8:00 am to 5:30 pm, Arizona Time