Insurance Authorization Professional

Insurance Authorization Professional

Requirements

• High School Diploma/GED Equivalent in General Studies
• Strong working knowledge of various insurance payers, payer plans, and program contract requirements

Responsibilities

• Collaborate with healthcare providers, clinical staff, and various departments to secure necessary authorization for services while maintaining compliance with all regulatory requirements.
• Accurately verify patient insurance eligibility and benefits coverage using various tools.
• Assess service requests to determine the need for pre-certification, pre-authorization, or referrals, and communicate effectively with relevant stakeholders.
• Maintain a strong working knowledge of various insurance payers, payer plans, and program contract requirements.
• Document pre-authorization information accurately in the EHR system.
• Engage with departments and clinical staff to communicate the need for pre-authorizations or referrals promptly.
• Identify high-risk requests that may require financial assistance and counseling.
• Advocate for patients and providers by addressing challenges related to pre-authorization approvals and denials.
• Provide backup support for Patient Admissions and Registration as needed.
• Create a positive service experience by being polite, compassionate, and professional with all internal and external customers.

Preferred Qualifications

• 1+ years in Health Care Services, Customer Service, Patient Scheduling, Patient Billing Experience
• Associates degree in Healthcare Related Field