Preauthorization Representative

Works within a team environment pre‑authorizing outpatient exams for various hospital services. This position requires a degree of complexity and prior anatomy education. Reports directly to the Pre‑Authorization Supervisor.

Communication

• Promptly answers the telephone in a professional and courteous manner.
• Demonstrates the knowledge and ability to utilize various computer networks and telephone applications to procure pre‑authorizations for patients.
• Demonstrates the ability to complete pre‑authorizations in a timely manner.
• Communicates courteously and effectively with internal and external customers.
• Understands both CPT, ICD‑9 and medical terminology.
• Checks appointment schedules daily to ensure all admissions and procedures have been approved (pre‑authorized) by the insurance carrier.

Clerical

• Demonstrates insurance knowledge.
• Knowledge of ICD‑9 coding / CPT / HCPCs to ensure Arnot Health receives the maximum allowable reimbursement.
• Knowledge of Medicare requirements for approved ICD‑9 codes and ability to communicate to the provider when a code is not approved; knowledge of Medicare waivers.
• Accurately pre‑authorizes / pre‑certifies patient exams for all departments to ensure smooth daily operation.
• Knowledge of proper sequencing of exams (prioritization).
• Communicates all questions to the appropriate department.
• Conferences with other departments to resolve pre‑authorization problems.
• Cross‑trained to other departmental responsibilities as required by the Supervisor/Director.

Computer

• Demonstrates basic computer skills.
• Works within Arnot Health’s computer system.
• Maintains computer security.

Working Relationship

• General knowledge of the hospital’s departments and their interactions.
• Interacts with physicians and physician offices in a positive and courteous manner.
• Establishes and maintains collaborative working relationships with other health‑team members.
• May perform other duties as requested by supervisor/manager to contribute to smooth department operation.

Quality

• Demonstrates reliability in the conscientious, complete and accurate manner in which work assignments are performed.
• Applies Quality Improvement principles in daily work and participates in QI monitoring and reporting.

Quantity

• Demonstrates flexibility in work schedule to meet department needs.
• Performs multiple tasks as required by the position.
• Utilizes time efficiently, sets priorities, and uses good organizational skills.

Safety

• Functions with awareness of risk management and safety issues; reports concerns appropriately.
• Maintains complete understanding of Arnot Health’s emergency codes.

Professionalism

• Is accountable for own actions.
• Maintains professional behavior and appearance; wears Arnot Health’s ID badge.
• Maintains and respects patient confidentiality.
• Addresses internal and external customers in a pleasant and respectful manner, displaying courtesy at all times.
• Attends staff meetings.

Other

• Responsible for attending all annual mandatory educational programs as required by the position.
• Understands and demonstrates the importance of satisfying customer/patient needs by interacting in a friendly, caring, and attentive manner, both psychologically and physically, and by maintaining communication to provide a secure and pleasant experience with Arnot Health.
• This job description lists typical duties for the classification and is not exhaustive of all duties that may be assigned.

Education

Mandatory: Clinical experience in various areas and/or coding experience. ICD‑9/CPT coding certifications or prior billing experience. High school diploma or equivalent required. Hospital experience preferred.

Experience

• Good organizational, communication, and customer relations skills.
• Telephone courtesy.
• Service‑oriented experience preferred.

CPR Requirements

No CPR required.

Physical Demands

Light physical effort. Typical office job.

Exposure Category

Category III – tasks that involve no exposure to blood, body fluids, or tissues. Category I tasks are not a condition of employment.