Registration Representative/Preauthorization Representative

Memorial Health•Decatur, IL

3d•Onsite

About The Position

The Registration Representative/Preauthorization Representative is responsible for reviewing all DMH and Memorial Care scheduled inpatient and outpatient procedures, as well as outpatient diagnostic services. The goal is to ensure that each scheduled service meets all required insurance and clinical documentation standards prior to the service date.

Requirements

Knowledge of medical terminology, insurance preauthorization processes, and payor requirements.
Ability to interpret and verify clinical documentation.
Strong organizational and communication skills.
High school diploma or GED required.
Previous experience in customer service required.
Familiarity with medical terminology or willingness to learn.
Above average computer skills, including proficiency in Microsoft Word, Excel, and scheduling or preauthorization software applications.

Nice To Haves

Experience with electronic health records (EHR) and scheduling systems preferred.
Knowledge of medical service coding preferred.

Responsibilities

Understands and applies payor-specific prior authorization requirements, staying up to date with policy and procedural changes from insurance providers.
Serves as a liaison between hospital staff and physician offices, ensuring accurate communication of outpatient diagnostic service needs and referral information.
Acts as a key contact for Utilization Review and Patient Financial Services, offering accurate and timely information as needed.
Receives and coordinates pre-authorizations (including RQIs) for all outpatient services and schedules inpatient admissions as required.
Coordinates physician referrals on appropriate patient accounts, ensuring additional services are authorized and scheduled as needed.
Schedules, coordinates, and pre-authorizes all necessary services as ordered by physicians.
Manages incoming phone calls professionally and efficiently to support departmental objectives and customer service expectations.
Prioritizes scheduled patients in compliance with managed care preauthorization requirements and medical necessity protocols.
Accurately documents all relevant case information using the account note function, including: Telephone conversations, Consultations, Authorization details, Reference numbers, Case rationale.
Maintains a high level of customer service by following internal quality standards and confidentiality policies.
Communicates regularly with case managers, physician offices, and nurses to secure necessary approvals and updates on patient accounts.
Maintains accurate and current records of insurance and pre-authorization details.
Identifies and communicates barriers to service or process improvement opportunities to management.
Assists in the training of new personnel and supports implementation of new workflows or procedures.
Performs other duties as assigned, contributing to the success and adaptability of the department.