Prior Authorization Representative

Banner Health

1d•Onsite

About The Position

Good health care is key to a good life. At Banner Health, we understand that, and that’s why we work hard every day to make a difference in people’s lives. We’ve united under a common goal: Make health care easier, so life can be better. It’s a lofty goal, but it’s one we’re committed to seeing through. Do you like the idea of making a positive change in people’s lives – and your own? If so, this could be the perfect opportunity for you. Apply now. As the Prior Authorization Representative you will manage insurance authorization requests, verify eligibility and data entry for medical services. This fast-paced role involves coordinating between providers, patients, and payers to ensure compliance and timely care. Monday – Friday, 8AM-4:30PM Banner University Medical Group is our nonprofit faculty practice plan associated with the University of Arizona Colleges of Medicine in Phoenix and Tucson. Our 1,100-plus clinicians provide primary and specialty care to patients at highly ranked Banner - University Medical Centers and dozens of clinics while providing mentorship to more than 1,200 residents and fellows. Our practice values and encourages the three-part mission of academic medicine: research, education and excellent patient care. POSITION SUMMARY This position is responsible for obtaining and processing all pertinent clinical information needed for the authorization of professional and medical services. The position responds to patient referrals and works insurance companies to pre-certify services based on the patient’s benefit plan. CORE FUNCTIONS 1. Responds to patient referrals for tests, procedures, and specialty visits. Obtains authorizations required by various payors; including verification of patient demographic information, codes, dates of service, and clinical data. Re-certifies services when necessary. 2. Authorizes and schedules appointments. Answers questions regarding the authorization process and supplies information to physicians, patients, and third party payers. May, depending on department/location, inform patients about necessary preparation for procedure or test. 3. Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing. Provides information about the referral process to physician and staff and informs them of eligibility issues. Works with staff and patients regarding denials and appeals. 4. Documents and maintains records of all referral activity and authorizations. 5. Performs other related duties as assigned. This may include cross-coverage in other areas. 6. This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision.

Requirements

High school diploma/GED or equivalent working knowledge.
Must possess effective verbal and written communication skills.
Must be proficient with commonly used office software.

Nice To Haves

One or more years of experience normally gained in a medical office or insurance environment.
Previous knowledge of managed care concepts.
Working knowledge of medical terminology and ICD9 and CPT codes.
Additional related education and/or experience preferred.

Responsibilities

Responds to patient referrals for tests, procedures, and specialty visits.
Obtains authorizations required by various payors; including verification of patient demographic information, codes, dates of service, and clinical data.
Re-certifies services when necessary.
Authorizes and schedules appointments.
Answers questions regarding the authorization process and supplies information to physicians, patients, and third party payers.
May, depending on department/location, inform patients about necessary preparation for procedure or test.
Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing.
Provides information about the referral process to physician and staff and informs them of eligibility issues.
Works with staff and patients regarding denials and appeals.
Documents and maintains records of all referral activity and authorizations.
Performs other related duties as assigned.
This may include cross-coverage in other areas.
This position has frequent communications with patients, physicians, staff, and third party payers.
The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision.