Precertification and Authorization Rep-Remote
About The Position
The Precertification and Authorization Representative is an intermediate level position responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. This position may also handle pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department, including processing pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, and working assigned registration denials for government and non-government accounts. The role emphasizes adherence to quality assurance guidelines and established productivity standards.
Requirements
- Knowledge of referral, precertification, and prior authorization processes
- Understanding of insurance specific plan requirements for commercial, government, and other payors
- Familiarity with hospital (inpatient & outpatient), ED, and clinic/ambulatory environments
- Ability to perform pre-appointment insurance review (PAIR)
- Ability to perform denials recovery functions
- Knowledge of workers compensation/third party liability (WC/TPL), managed care, and HMO accounts
- Ability to work assigned registration denials
- Adherence to quality assurance guidelines
- Adherence to established productivity standards
Responsibilities
- Resolve referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments
- Perform pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department
- Process pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts
- Work assigned registration denials for government and non-government accounts
- Adhere to quality assurance guidelines
- Adhere to established productivity standards to support the work unit’s performance expectations
Benefits
- Competitive compensation
- Comprehensive benefit plans
- Continuing education opportunities
- Advancement opportunities
- Medical: Multiple plan options
- Dental: Delta Dental or reimbursement account for flexible coverage
- Vision: Affordable plan with national network
- Pre-Tax Savings: HSA and FSAs for eligible expenses
- Retirement: Competitive retirement package to secure your future
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
