Precertification and Authorization Rep-Remote
About the position The Precertification and Authorization Representative is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations.
Requirements
- High School Diploma or GED and 2+ years of relevant experience required OR Bachelor’s degree required
- Ability to read and communicate effectively
- Basic computer/keyboarding skills, intermediate mathematic competency
- Good written and verbal communication skills
- Knowledge of proper phone etiquette and phone handling skills
- Position requires general knowledge of healthcare terminology and CPT-ICD10 codes.
- Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view.
- Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.
Nice-to-haves
- Prior Auth / Authorization experience
- Cancer Services experience
- Microsoft Office experience
- Radiation Oncology experience
- Insurance Verification experience
- Appeals experience
- Pre Determination experience
- Basic knowledge of and experience in insurance verification and claim adjudication is preferred.
- Knowledge of Denial codes is preferred.
- Knowledge of and experience using an Epic RC/EMR system is preferred.
- Healthcare Financial Management Association (HFMA) Certification Preferred.