What are the responsibilities and job description for the Insurance Authorization Representative position at Aurora Health Care?
Major Responsibilities
- Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems.
- Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.
- Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
- Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
- Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
- Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.
- May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
- Maintains files for referral and insurance information, and enters referrals into the system.
- Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
- None Required.
- High School Graduate.
- Typically requires 1 year of experience in providing customer service that includes experiences in patient accounts, third- party payer plans, accounts receivable/collection processes, and medical clinic processes and workflow.
- Knowledge of third-party payers and pre-authorization requirements.
- Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / pre-certification / authorization processes.
- Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, physician practice management, and electronic medical records systems.
- Strong analytical, prioritization and organizational skills.
- Ability to work independently with minimal supervision and to manage multiple priorities.
- Exceptional communication and interpersonal skills with a high degree of diplomacy and tact. Ability to effectively communicate with a variety of people under stressful circumstances.
- Exposed to a normal medical office environment.
- Sits the majority of the workday.
- Operates all equipment necessary to perform the job.
Salary : $20 - $31