Authorization Representative - Full-Time - AVALA ORTHO - RO45

AVALA•Covington, LA

1d•Onsite

About The Position

The Authorizations Representative is responsible for obtaining written, electronic and telephone prior authorizations as requested by insurance payers/providers for our patients within established timeframes and guidelines. This position also completes data entry and provider notification to ensure timely service to members and answers a high volume of calls within contract-mandated timeframes.

Requirements

High school diploma.
Knowledge of medical terminology, procedures, and diagnosis
Knowledge of computer and relevant software applications
Demonstrate knowledge of state, federal, and third-party claims processing required.
Clinical experience with electronic health record software
Educated on and compliant with HIPAA regulations; maintains strict confidentiality of client information.
Ability to communicate effectively in English, both verbally and in writing.
Planning and organizing
Information collection and management
Customer service skills
Excellent interpersonal and organization skills

Nice To Haves

Minimum two (2) years insurance resolution experience resolving issues with patients preferred.

Responsibilities

Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements for procedures, DME, imaging, labs, medications etc.
Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed.
Appeals for additional services (extended stays, visits, authorization extension, letter of medical necessity) and refers to additional resources when necessary.
Record insurance information to maintain data through the Referral/Insurance Verification process and communicates insurance information to pertinent staff including therapists, coding, and finance.
Independently maintains and works from the electronic medical record and additional databases.
Responsible for sending the Plan of Care/imaging/referral notes, etc. to insurance companies.
Track a significant amount of data and information, preparing and producing meaningful reports and information.
Works closely with clinical staff to ensure CPT codes and ICD-10 codes are accurate.
Obtains information necessary to complete the pre-authorization and scheduling of an order.
Researches and works with staff and billing company in resolving and resubmitting denied, rejected, and incorrectly paid claims including a review of timely submission and other processing procedures.
Responds professionally to all inquiries from patients, staff, and payors in a timely manner, as well as keeps patients informed of authorization status if within 72 hours of the scheduled date.
Keeps management informed of changes in authorization process, insurance policies, billing requirements, rejection, or denial codes as they pertain to claim processing and coding.
Accurately documents patient accounts of all actions taken.
Educates clinic management and staff regarding changes to insurance and regulatory requirements.
As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.
Ensures reports have minimal errors by developing, correcting, and executing comprehensive testing plan of modifications, new codes, etc.
Identify opportunities for process improvement for receipt of data and reporting.
Ability to meet established deadlines timely, accurately and with a sense of urgency.
Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details.
Notifies supervisor of known or potential insurance coverage issues
Review information for admission and continued visit management including type and duration of service, authorization and treatment codes, re-authorization and continued visit requirements necessary for ongoing treatment and payment.
Review scheduled procedures and orders to ensure they follow guidelines and are scheduled correctly.
Order medications following authorization approval, such as Botox, Synvisc, etc.
Perform financial analysis of each case and informs patient of financial responsibility if requested.
Other duties as assigned/ required.