Pre-Authorization Representative I

About the role

This job is responsible for ensuring that payers are prepared to reimburse AHN for scheduled services in accordance with the payer-provider contract. The representative contacts payers to request service authorization and may collect financial and or demographic information from patients and refers accounts to financial advocates if authorization is not obtained as needed.

Responsibilities

• Obtains prior authorizations from third-party payers in accordance with payer requirements.
• Remains current on all regulations, policies and procedures and process changes that are essential to completing assigned daily tasks. (50%)
• Verifies patient's Insurance and benefits information. Performs any written and/or verbal communication necessary to exchange information with designated contacts. (15%)
• Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality. (10%)
• Works with other departments to gather the clinical information required by the payer to authorize services. (5%)
• Works with business office to support appeal efforts for authorization-related denials. (5%)
• Maintains accurate records of authorizations within the EMR. (5%)
• Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR. (5%)
• Identifies patients who will need to receive Medicare Advance Beneficiary Notices of noncoverage (ABNs). (5%)
• Performs other registration duties as requested

Qualifications

• Minimum Associate's Degree Healthcare or Business Administration OR 3 years of related experience in a Healthcare setting
• 1 year with medical terminology and healthcare insurance processes
• Excellent communication and customer service skills
• Proficiency in the use of healthcare information systems
• Ability to prioritize and multitask
• Maintains professional tone at all times when communicating with patients and payer representatives
• Critical problem solving skills
• Experience within financial clearance setting
• Strong attention to detail
• Patient Access certification (preferred)
• Revenue Cycle Specialist certification (preferred)

Pay

Pay Range Minimum $19.25 – Pay Range Maximum $29.07. Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential.