Authorization Representative
About The Position
This position is responsible to obtain insurance eligibility and benefits information and obtain required authorizations. Reviews all insurance eligibility responses and communicates with the physician's office and insurance companies as needed regarding these responses or to obtain correct information. Works with Utilization Review staff to ensure authorizations cover services needed. May also estimate cost of service and patient's responsibility. Refers patients with questionable insurance coverage to the Eligibility Counselors. May assist in mentoring new hires.
Requirements
- Two years of customer service experience.
- Demonstrated good communications and computer skills.
Nice To Haves
- Demonstrated knowledge of medical terminology.
- Experience in admitting, billing, collections, and/or insurance verification.
- Bi-Lingual Spanish speaking.
- Demonstrated knowledge of CPT/ICD-9 codes.
- Interact with others requiring the employee to communicate information.
- Operate computers and other office equipment requiring the ability to move fingers and hands.
- See and read computer monitors and documents.
- Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Responsibilities
- Obtains insurance eligibility and benefit information using various phone and on-line resources.
- Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.
- Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe.
- Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement.
- Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.
- Immediately refers 'at risk' admission to eligibility, i.e., out of network, underinsured, max benefits, etc.
- Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays.
- Maintains a satisfactory level of performance and adherence to workload standards.
- Estimates cost of service using ICD-9 or CPT codes.
- Interprets 271 response, including insurance terminology, in online tool to determine patient responsibility.
- Performs calculations using insurance benefit information to accurately estimate patient responsibility.
- May lead and/or train new employees in account preparation and review functions.
Benefits
- We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
- Learn more about our comprehensive benefits package here.
- Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
