Insurance Authorization Representative

Sturdy Memorial Hospital•Attleboro, MA

6d•Hybrid

About The Position

Determine and monitor the insurance and authorization status of all Inpatient, Observation and Surgical Day Care accounts. Responsible for tracking and arranging copayment collection where applicable.

Requirements

High School Diploma or Equivalency
Minimum of 1-3 years of experience in a healthcare related field.
Interpersonal skills to effectively interact with patients, physician offices, insurance companies and departments throughout the hospital.
Discipline and professionalism to work independently and within a team structure.
Ability to complete time sensitive tasks within guidelines.
Ability to use various software and office equipment.
Ability to sit for prolonged periods of time.
Sit while working at computers.
Use hands to manage, control, or feel objects, tools, or controls.
Repeat the same motions.
See details of objects that are less than a few feet away.
Speak clearly so listeners can understand.
Understand the speech of another person.
Must be able to lift up to 15 pounds at times.

Nice To Haves

Previous experience obtaining prior authorizations in a hospital setting.
Third party knowledge
Business office experience
Medical terminology/knowledge
Cerner experience.
Familiarity with verifying insurance coverage and allowable benefits
Critical thinking skills.
Detail oriented.

Responsibilities

Obtain precertification/ authorization for inpatient and observation patients presenting through the Emergency Department.
Run payer eligibility, review self-pay and refer to Financial Counselors as applicable.
Review surgical and endoscopic cases for accuracy and completion.
Run daily reports as required.
Compliance with HIPAA.
Call payers and/or electronically obtain prior authorization for departments within the hospital.
Work with outside offices to ensure they are obtaining Prior Authorization.
Work closely with case management department to ensure clinicals have been sent to the payer.
Call payers for follow-up on prior authorization status.