Preauthorization Representative

Position#Summary: The Pre-Authorization Representative will ensure they gather all information needed to#attempt to complete approval of any Radiology and/or Procedures.

This requires the PA Rep#to process the entire Pre-Authorization process to include all current insurances, PA#requirements, gathering all information from the chart and scheduling Peer to Peer reviews#when required. The PA Rep will continually follow up with insurance companies, Medical#offices, Central Scheduling, Provider and the patient to keep all updated through the process#until completed.

Primary Position Responsibilities:

1. Responsible for ensuring that insurance requirements and financial obligations are obtained#and communicated to patients as appropriate for collection of elective hospital services prior#to date service and/or billing. 2. Maintain knowledge in pre-certification processes and policies. #Keeps up to date with#insurance changes/requirements pertaining to Prior Authorizations. 3.
   
   Secures pre-certification as quickly as possible, in the appropriate timeframe per insurance. 4. Obtains medical necessity verification. Updates Prior Authorization information in all relevant#systems. 5.
   
   Collaborates closely with Central Scheduling team to ensure the patient is scheduled as#quickly as is appropriate. 6. Communicates pre-authorization status and financial responsibility as appropriate to patients#for scheduled procedures. 7. Assists with other clerical duties as needed.

Qualifications:

Minimum Education: Required: High School Diploma or Equivalent Preferred: None

Minimum Years of Experience:

Required: One year of medical office/hospital registration/patient accounting experience Preferred:

Knowledgeable in pre-certification processes and policies # License, Registry or Certification: Required: None Preferred: None # Knowledge, Skills and/or Abilities:

Required:

PC Skills, Excellent Customer service skills, Detailed oriented, Multi-tasking skills Preferred: Medical terminology, Insurance knowledge

Position Summary:

The Pre-Authorization Representative will ensure they gather all information needed to attempt to complete approval of any Radiology and/or Procedures.

This requires the PA Rep to process the entire Pre-Authorization process to include all current insurances, PA requirements, gathering all information from the chart and scheduling Peer to Peer reviews when required. The PA Rep will continually follow up with insurance companies, Medical offices, Central Scheduling, Provider and the patient to keep all updated through the process until completed.

Primary Position Responsibilities:

1.Responsible for ensuring that insurance requirements and financial obligations are obtained and communicated to patients as appropriate for collection of elective hospital services prior to date service and/or billing.

2.Maintain knowledge in pre-certification processes and policies. Keeps up to date with insurance changes/requirements pertaining to Prior Authorizations.

3.Secures pre-certification as quickly as possible, in the appropriate timeframe per insurance.

4.Obtains medical necessity verification. Updates Prior Authorization information in all relevant systems.

5.Collaborates closely with Central Scheduling team to ensure the patient is scheduled as quickly as is appropriate.

6.Communicates pre-authorization status and financial responsibility as appropriate to patients for scheduled procedures.

7.Assists with other clerical duties as needed.

Qualifications:

Minimum Education:

Required: High School Diploma or Equivalent

Preferred: None

Minimum Years of Experience:

Required: One year of medical office/hospital registration/patient accounting experience

Preferred:

Knowledgeable in pre-certification processes and policies

License, Registry or Certification:

Required: None

Preferred: None

Knowledge, Skills and/or Abilities:

Required: PC Skills, Excellent Customer service skills, Detailed oriented, Multi-tasking skills

Preferred: Medical terminology, Insurance knowledge