Revenue Cycle Representative (Prior Authorization) - Patient Access Management (PAM) - Patient Financial Services (PFS)

About the role

This position serves as a Revenue Cycle Representative within the Patient Access Management (PAM) and Patient Financial Services (PFS) department. The primary responsibility is to manage prior authorization requests and ensure timely and accurate processing of claims.

Responsibilities

• Handle prior authorization requests for various insurance plans.
• Communicate effectively with patients, providers, and payers to resolve issues and obtain necessary approvals.
• Process claims accurately and efficiently, ensuring compliance with insurance guidelines and regulations.
• Provide exceptional customer service to patients and providers, addressing their concerns promptly and professionally.
• Monitor and update patient records to reflect changes in insurance coverage and eligibility.
• Collaborate with other departments to ensure seamless patient flow and financial outcomes.

Requirements

• High school diploma or equivalent.
• 6 months or more of related customer service experience in a professional, financial, or health care related environment.
• Knowledge of healthcare billing (healthcare revenue cycle); insurance, and/or federal and state assistance programs.
• Strong attention to detail and accuracy to achieve or exceed organizational and individual performance goals.
• Proficient in computer software applications, including Microsoft Office Suite (Excel, Word, Outlook, PowerPoint).
• Demonstrated ability to handle complex and ambiguous situations with minimal supervision.
• Self-motivated with initiative to seek out additional responsibilities, tasks, and projects.
• Effective communication skills (written and verbal), active listening skills, and the ability to maintain professionalism while handling demanding situations with callers or customers.
• Successful history collaborating in a fast-paced team environment.

Qualifications

• Experience working in a complex hospital system is highly desirable.
• Experience handling difficult callers, customers, and patients.
• Experience and knowledge of Patient Financial Services’ functions, systems, processes & policies.
• Demonstrated ability to maintain or improve established productivity and quality requirements.
• Knowledge of medical terminology.
• Knowledge of anatomy and physiology.
• Knowledge of Health Insurance Portability and Accountability Act (HIPAA) laws.
• Experience identifying opportunities for improvement and making recommendations and suggestions.
• Experience with multiple technology platforms such as Epic, Cirius ACD, and/or GE.
• Ability to drive results and foster accountability throughout the team and organization.
• Maintain current awareness of industry trends and continually strive for improvement with both technical and professional skills.

Skills

• Excellent written and verbal communication skills.
• Active listening skills.
• Problem-solving abilities.
• Time management and organizational skills.
• Adaptability and flexibility.
• Ability to work independently and as part of a team.

Benefits

• Comprehensive health insurance benefits.
• Paid time off and holidays.
• Flexible work schedule.
• Professional development opportunities.

Pay

Salary range: $35,000 - $45,000 per year

Schedule

Full-time position, 40 hours per week.