What are the responsibilities and job description for the Pre Authorization Rep position at CommonSpirit Health?
Job Summary And Responsibilities
As a Pre-Authorization Representative, you will be responsible for ensuring a smooth and efficient pre-admission and pre-authorization process for all patients, safeguarding necessary financial clearance before services are rendered.
Every day, you will accurately gather and verify patient demographic and insurance information, obtain necessary pre-certifications and authorizations from insurance companies, and communicate financial responsibilities to patients. You will serve as a key point of contact, coordinating with physicians' offices, insurance providers, and hospital departments to facilitate seamless patient access to care. Your work directly contributes to preventing claim denials and ensuring financial integrity.
To be successful in this role requires meticulous attention to detail, strong knowledge of insurance practices and medical terminology, excellent communication skills, and a commitment to patient advocacy and financial accuracy.
Required
CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.
Pay Range
$18.06 - $25.51 /hour
As a Pre-Authorization Representative, you will be responsible for ensuring a smooth and efficient pre-admission and pre-authorization process for all patients, safeguarding necessary financial clearance before services are rendered.
Every day, you will accurately gather and verify patient demographic and insurance information, obtain necessary pre-certifications and authorizations from insurance companies, and communicate financial responsibilities to patients. You will serve as a key point of contact, coordinating with physicians' offices, insurance providers, and hospital departments to facilitate seamless patient access to care. Your work directly contributes to preventing claim denials and ensuring financial integrity.
To be successful in this role requires meticulous attention to detail, strong knowledge of insurance practices and medical terminology, excellent communication skills, and a commitment to patient advocacy and financial accuracy.
- Responsible for obtaining all pre-authorizations for planned outpatient cardiac imaging ordered by Mountain Management Services providers throughout the practice.
- Interact with coding staff to ensure that medical necessity requirements are met.
- Ensure timely updates of payer coverage.
- Maintain vendor and payer worksheets for all cardiac imaging modalities
- Track and reconcile pre-authorization denials for process improvement
- Notify Manager/Director of documentation improvement opportunities.
Required
- High School Graduate General Studies or High School GED General Studies, upon hire
- Two years’ experience with pre-certifications and/or referrals
CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.
Pay Range
$18.06 - $25.51 /hour
Salary : $18 - $26