Patient Authorization Representative II

UMC Health System•Bluesky, AB

1d•Onsite

About The Position

Patient Authorization Representative is responsible for verifying insurance eligibility and ensuring all authorizations for pre certifications, inpatient and out- patient exams/ test are received. Cancer Center Patient Authorization Representatives work with Financial Aid Office for screening determination of 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