Patient Authorization Representative II

UMC Health System

3d•Onsite

About The Position

The Patient Authorization Representative II is responsible for verifying insurance eligibility and ensuring all authorizations for pre-certifications, inpatient, and out-patient exams/tests are received. This role involves coordinating referrals and pre-certifications, performing administrative duties, communicating with various stakeholders to ensure continuity of care and financial responsibility, collecting payments, and managing authorizations for specific patient discharges. The Cancer Center Patient Authorization Representatives also work with the Financial Aid Office for screening determination of a patient's ability to pay.

Requirements

High School Diploma or GED
+3 years of experience working with insurance verifications and pre certifications, preferably in a hospital setting
+3 years use of medical terminology
Excellent customer service skills; Must speak, read, and write English fluently
Ability to multi-task, handle problems, interruptions, and other stressful situations in a professional manner.
Demonstrate planning, organizational and ability to follow-through until a process is complete.

Nice To Haves

preferred knowledge CPT codes, procedure codes and DRG’s classifications.

Responsibilities

Verify insurance eligibility and benefits
Obtain and update patient benefits, identifying limitations and/or exclusions for each particular plan as it pertains to the patient’s care
Coordinate physician and/or facility referrals and pre certifications for patient appointments
Perform office administrative duties such as scheduling, processing POs/invoices, scanning, faxing, answering and routing phone calls, etc.
Communicate with other hospital departments, insurance companies, and at times, patient’s family members to ensure continuity of care for reoccurring appointments, financial responsibility, and to ensure facility receives maximum reimbursement for services provided
Collect payments, establish payment arrangements, discuss payment options
Inpatient, Observation and Surgical management of authorization/referrals and clinical processes.
Submit timely authorization and referrals using CPT, diagnosis and procedure codes.
Submit authorization on IPSNF, IPREHAB and IPLTC to ensure expedited patient discharges.
All other related assigned duties
Work with Financial Aid Office for screening determination of patient’s ability to pay