Prior Authorization Representative Neurology

Banner Health•Mesa, AZ

14d•Onsite

About The Position

The Prior Authorization Representative (PFS) is responsible for obtaining and managing insurance authorizations for medical imaging, procedures, specialty medications, and other healthcare services to ensure timely patient access to care. This role serves as a liaison between providers, medical assistants, patients, and insurance companies to facilitate the authorization process, resolve authorization-related issues, and prevent delays in treatment. This position coordinates a smooth patient flow process by answering phones, scheduling patient appointments, providing registration of patient and insurance information, obtaining required signatures following established processes, procedures and standards. This position also verifies insurance coverage, validates referrals and authorizations, collects patient liability and provides financial guidance to patients to maximize medical services reimbursement efforts. This also includes accurately posting patients at the point of service and releasing information in accordance with organizational and compliance policies and guidelines.

Requirements

High school diploma/GED or equivalent working knowledge.
Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience.
Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently.
Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.
Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.
Employees working at Banner Behavioral Health Hospital, BTMC Behavioral, and BUMG, BUMCT, or BUMCS in a Behavioral Health clinical setting that serves children must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.
An Arizona Criminal History Affidavit must be signed upon hire.

Nice To Haves

Work experience with the Company’s systems and processes is preferred.
Previous cash collections experience is preferred.
Additional related education and/or experience preferred

Responsibilities

Performs registration/check-in processes, including but not limited to performing data entry activities, providing patients with appropriate information and intake forms, obtaining necessary signatures and generating population health summary.
Verifies insurance eligibility benefits for services rendered with the payors and documents appropriately. Assists in obtaining or validating pre-certification, referrals, and authorizations.
Calculates and collects patient liability according to verification of insurance benefits and expected reimbursement. Explains and provides financial policies and available resources for alternative payment arrangements to patients and their families.
Enters payments/charges for services rendered and performs daily payment/charge reconciliation in a timely and accurate manner. Balances cash drawer at the beginning and end of the day and prepares daily bank deposit with necessary paperwork sent to centralized billing for record purposes.
Schedules office visits and procedures within the medical practice(s) and external practices as necessary. Maximizes reimbursement by scheduling patients in accordance with payor plan provisions. Confirms patient appointments for the following day as necessary and ensures patients are properly prepared for visits.
Demonstrates proactive interpersonal communications skills while dealing with patient concerns through telephone calls, emails and in-person conversations. Optimizes patient flow by using effective customer service/communication skills by communicating to internal and external customers, care team, management, centralized services and HIMS.
Assists in responding to requests for patient medical records according to company policies and procedures, and state and federal laws.
Provides a variety of patient services to assist in patient flow including but not limited to escorting patients, taking vitals and patient history, assisting in patient treatment, distributing mail and fax information, ordering supplies, etc.
Works independently under regular supervision and follows structured work routines. Works in a fast paced, multi-task environment with high volume and immediacy needs requiring independent decision making and sound judgment to prioritize work and ensure appropriateness and timeliness of each patient’s care. This position requires the ability to retain large amounts of changing payor information/knowledge crucial to attaining reimbursement for the services provided. Primary external customers include patients and their families, physician office staff and third party payors.