OP Therapy Authorizations Rep

Parkview Health•Fort Wayne, IN

About The Position

The OP Therapy Authorizations Rep identifies scheduled outpatient therapy patients whose insurance requires pre-authorization and ensures authorization is obtained. The role verifies benefits for identified services, communicates benefit details to the requesting department, and informs patients when services lack authorization or are out of network. It evaluates accounts individually and promptly to determine precertification requirements using established criteria, documents authorization information accurately in related billing systems, and follows up on denials and appeals to secure insurance approval and minimize organizational write-offs. The representative fills in as an OP Therapy Scheduling Representative as needed and is responsible for data integrity across systems, quality performance, service excellence, and delivery of Parkview Health Standards of Behavior. The role requires effective communication, attention to detail, problem-solving, troubleshooting, time management, multitasking, and the ability to adapt to change and work in a stressful, fast-paced environment. Professional appearance and adherence to the clinic or facility dress code are expected. The employee must be willing to work at other locations as assigned.

Requirements

High school graduate or equivalent GED.
Minimum of two years of experience in a health care setting, call center, or clerical position.
Excellent verbal and written communication skills.
Working knowledge of general computer skills and applications.
Ability to multitask and work independently using critical thinking skills.
Ability to perform at a high level in a fast-paced and stressful environment and adapt to constant change.
Excellent attention to detail, problem-solving, troubleshooting, and time-management skills.
Professional appearance and adherence to the clinic or facility dress code.
Willingness to work at other locations as assigned.

Nice To Haves

Knowledge of medical terminology.
Experience using Microsoft Office applications.
Registration experience.
One year of insurance pre-authorization experience.

Responsibilities

Identify scheduled outpatient therapy patients whose insurance requires pre-authorization and ensure authorization is obtained.
Verify benefits for identified services and communicate benefit details to the requesting department.
Communicate with patients regarding lack of authorization or out-of-network services.
Evaluate each account promptly to determine precertification requirements using established criteria.
Accurately document pertinent authorization information in related billing systems.
Follow up on denials and appeals to obtain insurance approval and minimize organizational write-offs.
Fill in as an OP Therapy Scheduling Representative as needed.
Maintain data integrity in all systems used for job functions.
Deliver Parkview Health Standards of Behavior, quality performance, and service excellence.
Work at other locations as assigned.