Prior Authorization Representative Neurology

Location: Baywood Neurology, 6553 E Baywood Ave Ste 212, Mesa, AZ 85206

Clinic Hours: Monday–Thursday 8:30 AM–5:00 PM, Friday 8:00 AM–4:30 PM

About the role

This position coordinates a smooth patient flow process by answering phones, scheduling patient appointments, registering patient and insurance information, obtaining required signatures, and verifying insurance coverage. The Prior Authorization Representative (PFS) is responsible for obtaining and managing insurance authorizations for medical imaging, procedures, specialty medications, and other healthcare services to ensure timely patient access to care. This role serves as a liaison between providers, medical assistants, patients, and insurance companies to facilitate the authorization process, resolve authorization-related issues, and prevent delays in treatment.

Responsibilities

• Performs registration/check-in processes, including data entry, providing patients with intake forms, obtaining necessary signatures, and generating population health summaries.
• Verifies insurance eligibility benefits for services rendered with payors and documents appropriately.
• Assists in obtaining or validating pre-certification, referrals, and authorizations.
• Calculates and collects patient liability according to verification of insurance benefits and expected reimbursement.
• Explains financial policies and available resources for alternative payment arrangements to patients and their families.
• Enters payments/charges for services rendered and performs daily payment/charge reconciliation accurately and timely.
• Balances cash drawer at the beginning and end of the day and prepares daily bank deposit with necessary paperwork.
• Schedules office visits and procedures within the medical practice(s) and external practices as necessary, maximizing reimbursement by scheduling patients in accordance with payor plan provisions.
• Confirms patient appointments for the following day and ensures patients are properly prepared for visits.
• Demonstrates proactive interpersonal communication skills while addressing patient concerns via telephone, email, and in-person conversations.
• Optimizes patient flow by communicating effectively with internal and external customers, care teams, management, centralized services, and HIMS.
• Assists in responding to requests for patient medical records according to company policies and procedures, and state and federal laws.
• Provides a variety of patient services to assist in patient flow, including escorting patients, taking vitals and patient history, assisting in patient treatment, distributing mail and fax information, and ordering supplies.
• Works independently under regular supervision, following structured work routines in a fast-paced, high-volume environment requiring sound judgment and independent decision-making to prioritize work and ensure timely patient care.
• Retains large amounts of changing payor information/knowledge crucial to attaining reimbursement for services provided.

Requirements

• High school diploma/GED or equivalent working knowledge.
• Knowledge of patient financial services, financial, collecting services, or insurance industry processes, typically acquired over one or more years of work experience.
• Ability to manage multiple tasks simultaneously with minimal supervision and work independently.
• Strong interpersonal, oral, and written communication skills to interact effectively with a wide range of audiences.
• Proficiency in common office software, including word processing, spreadsheet, and database software.
• Employees working in a Behavioral Health clinical setting that serves children must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain it for the duration of employment. An Arizona Criminal History Affidavit must be signed upon hire.

Preferred Qualifications

• Work experience with Banner Health’s systems and processes.
• Previous cash collections experience.