PREAUTHORIZATION REP

About the role

Manages financial arrangements (insurance verification, precertification, charity review, etc.) for hospital patients to assure the hospital is reimbursed by third parties, financial assistance programs, and the patient/guarantor.

Responsibilities

• Coordinate the precertification authorization process as well as general insurance verification coverage.
• Perform authorization and eligibility checks in a timely manner including when new insurance is identified.
• Communicate and document pertinent third party payor issues and/or information regarding any change in authorization and eligibility to Intake Director, Business Office Manager, UM Director, and/or designee.
• Maintain professional, positive and effective communication.
• Collect necessary clinical and demographic data from patients, providers, and insurance companies to support precertification authorization requests.
• Verify and enter insurance eligibility in an accurate and timely manner.
• Notify Intake Director, Business Office Manager, UM Director, and/or designee regarding lack of payer coverage or other service non-coverage issues as it relates to completing precertification.
• Submit and track authorization requests with insurance providers, ensuring compliance with their specific requirements and deadlines for new and existing patients.
• Work directly with Assessment and Referral Services to stay abreast of admissions and/or pending authorizations.

Qualifications

• High school diploma