Authorization Representative

Immediate Opening: Authorization Representative

We have an exciting opportunity for an Authorization Representative at our corporate office in Murray. We are looking for a well-organized and professional team member with a positive demeanor to join our Accounts Receivable Department.

Key Responsibilities:

• Facilitate daily authorization requests with a variety of insurance carriers, including Commercial insurance companies nationwide, Utah and New Mexico State Medicaid plans, MCO/ACO Medicaid Plans, and Medicare Advantage plans.
• Obtain prior authorization for services from clients' medical insurance carriers.
• Review client orders and clinical notes to accurately request authorizations.
• Maintain up-to-date knowledge of insurance carriers' prior authorization requirements.
• Ensure that all procedure codes and units of measure align with the service, contract, and insurance guidelines.
• Communicate effectively with other departments to obtain necessary clinical documentation.
• Submit quality authorization/review documentation verbally, online, or via fax/email to insurance carriers.
• Document authorizations accurately and timely in our system and maintain detailed records.
• Follow up on delayed or denied authorization requests and escalate as needed.
• Advocate for clients regarding their care and insurance benefits.
• Respond to inquiries from patients, staff, and insurance companies about authorizations.
• Prioritize workflow to meet company and department needs.
• Problem-solve issues and identify optimal solutions.
• Provide backup coverage for the Re-Authorization Representative, including handling re-authorizations, monthly Medicaid eligibility checks, expiring authorization reports, and coverage during scheduled or unscheduled time off.
• Perform other tasks and duties as assigned.

• Schedule:

• Full-time, in-person position
• Monday through Friday, 8:00 AM to 5:00 PM

Skills, Qualifications, and Experience:

• Basic knowledge of accounting, Adobe, Microsoft Word, Outlook, and Excel.
• Strong attention to detail and accuracy.
• Ability to work efficiently in a fast-paced environment with changing tasks and interruptions.
• Proficient in multitasking and adapting to new or evolving information and procedures.
• Effective verbal and written communication skills.
• Ability to meet processing time standards.
• Professional and courteous in all customer interactions.

Requirements:

• High school diploma.
• Successful completion of a background check upon hire.

Physical demands and work environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of this job, the employee is required to perform job related duties which may require: lifting, standing, bending, stooping, stretching, walking, pushing, pulling, talking, and hearing. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. The noise level in the work environment is usually minimal.