Prior Authorization Representative

PA Representative

PA Representative will be responsible for prior authorizations for comprehensive pain services, administrative support of pain team providers, and integration within Anesthesiology & Pain Management administrative team. Administrative support duties include completion of reimbursement requests, meeting coordination, day to day office support, and special projects as assigned.

Job Description Summary : Processes pre-authorizations of exams or services ordered by Providers and performed at any NCH facility. Ensures that pre-authorizations are completed appropriately through communication to third party payers and collaboration with clinics.

Job Description : Essential Functions :

Participates in pre-authorization documentation process, obtaining, compiling, maintaining, and issuing necessary records, reports, ensuring accuracy of content and correct distribution. Documents pre-authorization information appropriately in the hospital information system, (HIS).

Contacts third party payer to obtain pre-authorization for ordered exam, providing updates as needed throughout the pre-authorization process.

Reviews pending pre-authorizations and provides follow up if needed.

Communicates to clinics when peer to peer is requested and reviews clinic progress on pre-authorizations that require additional detail for approval.

Provides additional information requested by Patient Accounts to assist in billing issues involving pre-authorization.

Education Requirement :

High School Diploma or equivalent, required.

Associate's Degree, preferred.

Skills :

Excellent customer service and communication skills.

Ability to work and problem solve with minimal supervision.

Ability to understand and retain complex and quickly changing information.

Knowledge of the impact of the revenue cycle on hospital operations.

Familiarity with medical terminology.

Ability to function as a team member responsible for staffing operational hours.

Ability to adapt to change positively in workflow and process.

Keyboarding, typing, or data entry skills.

Experience :

One year of pre-registration, registration, admitting, or customer service experience, preferred.

One year of experience in billing processes and insurance verification, preferred.

Working knowledge of HIS Work Queues.

Physical Requirements :

OCCASIONALLY : Decision Making, Standing, Walking

FREQUENTLY : Interpreting Data

CONTINUOUSLY : Audible speech, Computer skills, Flexing / extending of neck, Hand use : grasping, gripping, turning, Hearing acuity, Peripheral vision, Problem solving, Repetitive hand / arm use, Seeing Far / near, Sitting

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M / F / Disability / Vet