Patient Authorization Representative Lead

UMC Health System

2d•Onsite

About The Position

The Lead Patient Authorization Representative is responsible for verifying insurance schedules with staff, ensuring all authorizations for pre-certifications, inpatient and out-patient exams/tests are received. This role involves facilitating training, coordinating insurance schedules, verifying insurance eligibility and benefits, clearing insurance retro denials, and coordinating physician and/or facility referrals and pre-certifications for patient appointments. The Lead Representative also communicates with other hospital departments, insurance companies, and patient families to ensure continuity of care, financial responsibility, and maximum reimbursement. Additionally, they collect payments, establish payment arrangements, and discuss payment options. Cancer Center Patient Authorization Representatives work with the Financial Aid Office for screening determination of a patient's ability to pay.

Requirements

High School Diploma or GED
+5 years of experience working with insurance verifications and pre certifications, preferably in a hospital setting
+2 years leadership experience, leading people and processes
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.

Responsibilities

Facilitate training and ensuring updates to policies or procedures are communicated timely
Coordinate insurance schedules with staff; Verify insurance eligibility and benefits
Clear insurance retro denials
Coordinate physician and/or facility referrals and pre certifications for patient appointments
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
All other related assigned duties