Authorizations Representative Lead

Rewarding career. Competitive salary. Outstanding benefits.

TITLE: Authorizations Representative LEAD JOB CODE:

REPORTS TO: Manager of Patient Access DEPARTMENT: Clinic Patient Access

FLSA: Non-Exempt

SUMMARY

The Lead Authorizations Representative is primarily responsible for providing training and ongoing education to the authorization team. This role oversees staff scheduling and supports the team in obtaining prior authorizations for clinic patients, ensuring referrals are processed within the required 72-hour timeframe.

Additionally, the Lead Authorizations Representative collaborates with the Patient Care Access Manager by analyzing performance data, identifying opportunities for improvement, and researching current workflows to enhance efficiency while ensuring compliance with insurance requirements.

STANDARD EXPECTATIONS

· Promotes a Positive Working Environment

o Conducts oneself in line with organization’s mission, values and standards of behavior.

o Accepts change and challenges with a positive attitude.

o Consistently adheres to organizational policy.

· Communicates Effectively

o Builds relationships and works collaboratively with other staff.

o Provides timely operational updates to the Manager

o Responds to communications in a timely manner.

· Performs Duties Efficiently and Effectively

o Follows procedures.

o Acts in compliance with applicable federal, state, and local regulations.

o Performs other duties as assigned.

AREA OF RESPONSIBILITY DUTIES & RESPONSIBILITIES

Referrals · Monitors incoming referral/order requests from providers. · Confirms the physician or provider completes the clinical documentation required for a referral. · Submits referrals and all supporting clinical documentation within 72 hours of receiving from the physician or provider. · Briefs the patients on any preparation required for the visit. · Follows through with the established referral process in order to maintain continuity of care. · Responds to specialty care offices requests for additional information in a timely manner. · Assists patients in scheduling appointments if they have not been called by the specialty clinic or ‘referred to’ providers office.

Authorizations · Assesses the need for authorization requirement(s) based on the patient’s insurance carrier. · Stays up-to-date with changing insurance payer authorization requirements. · Submits authorizations within 72 hours of receiving from the physician or provider. · Regularly call insurance companies to follow up on all pending authorizations.

· Responds to insurance companies in a timely manner regarding requests for additional information. · Informs the patient of an approved or denied authorization and assists that patient with scheduling instructions. · Communicates with insurance companies to ensure benefit limitations have not been exceeded and communicates to the patient. · Works with providers to update authorization requests with appropriate ICD-10 codes to support the requested CPT code services. · Assists in scheduling peer-to-peer calls with WMC providers and insurance plans if needed.

Leadership · Acts as a resource and contact for all patients and WHMC team members in matters that involve patient referrals and authorizations. · Uses and understands insurance company websites and information exchange sites such as One Health Port and Availity. · Assists the Director of Clinics and Clinic Patient Access Manager with workflow and efficiency tracking to ensure the highest level of patient care possible.

QUALIFICATIONS

Required · One or more years of experience working with insurance verification.

Preferred · Previous experience as an Authorizations Representative. · One year of working in a medical office setting. · One year of experience with the patient registration process.

WORK ENVIRONMENT AND PHYSICAL DEMANDS

This position is primarily worked in an office environment. Primarily stationary with occasional standing, walking, lifting, reaching, carrying, kneeling, bending, stooping, pushing and pulling of objects weighing up to 20lbs. The position requires continuous finger dexterity and fine manipulation.

If you are looking for a rewarding career with a great team, you'll enjoy your career with us !

POSITION DETAILS

Hours per week:

Employee Status:

Shift:

Pay Range:

Actual pay offered will vary based on years of experience.

EMPLOYEE BENEFITS

Our benefit package includes medical, dental, vision, life insurance, and retirement options (403(b) & 457). Medical insurance coverage begins on day one and is available to both full time and part time employees. Additionally, employees receive discounts on medical services provided by Whitman Hospital and Medical Clinics. Differentials apply for evening, night, and weekend shifts. Our unique PTO plan enables employees to increase their accrual with each year of service!