Authorizations Representative Lead

Whitman Hospital and Medical Clinics•Colfax, WA

8d•$22 - $39•Onsite

About The Position

The Lead Authorizations Representative is primarily responsible for providing training and ongoing education to the authorization team. This role oversees staff scheduling and supports the team in obtaining prior authorizations for clinic patients, ensuring referrals are processed within the required 72-hour timeframe. Additionally, the Lead Authorizations Representative collaborates with the Patient Care Access Manager by analyzing performance data, identifying opportunities for improvement, and researching current workflows to enhance efficiency while ensuring compliance with insurance requirements.

Requirements

One or more years of experience working with insurance verification.

Nice To Haves

Previous experience as an Authorizations Representative.
One year of working in a medical office setting.
One year of experience with the patient registration process.

Responsibilities

Monitors incoming referral/order requests from providers.
Confirms the physician or provider completes the clinical documentation required for a referral.
Submits referrals and all supporting clinical documentation within 72 hours of receiving from the physician or provider.
Briefs the patients on any preparation required for the visit.
Follows through with the established referral process in order to maintain continuity of care.
Responds to specialty care offices requests for additional information in a timely manner.
Assists patients in scheduling appointments if they have not been called by the specialty clinic or ‘referred to’ providers office.
Assesses the need for authorization requirement(s) based on the patient’s insurance carrier.
Stays up-to-date with changing insurance payer authorization requirements.
Submits authorizations within 72 hours of receiving from the physician or provider.
Regularly call insurance companies to follow up on all pending authorizations.
Responds to insurance companies in a timely manner regarding requests for additional information.
Informs the patient of an approved or denied authorization and assists that patient with scheduling instructions.
Communicates with insurance companies to ensure benefit limitations have not been exceeded and communicates to the patient.
Works with providers to update authorization requests with appropriate ICD-10 codes to support the requested CPT code services.
Assists in scheduling peer-to-peer calls with WMC providers and insurance plans if needed.
Acts as a resource and contact for all patients and WHMC team members in matters that involve patient referrals and authorizations.
Uses and understands insurance company websites and information exchange sites such as One Health Port and Availity.
Assists the Director of Clinics and Clinic Patient Access Manager with workflow and efficiency tracking to ensure the highest level of patient care possible.