The Authorization Representative is responsible for performing insurance eligibility verification and ensures that all pre-certification, authorization and/or referral required by the insurance companies are obtained prior to the appointment for gastroenterology procedures for Digestive & Liver Disease faculty. This position requires communicating with practice administration, clinicians, office staff, and patients to obtain information and any clinical documentation required for authorization approval.
Verifies insurance and coordinates all aspects of securing accounts to include pre-registration, eligibility, benefits, and authorization for scheduled and/or same day appointments.
Reviews authorizations after services have been rendered and obtains updated authorization if service does not match what was authorized.
Perform follow-up functions to correct deficiencies in data collection utilizing available systems.
Documents and updates all registration, financial data and referral/authorization in IDX system and/or applicable system applications.
Responsible for the identification, correction and selection of appropriate insurance Financial Status Clarification (FSC).
Document any financial clearance issues through collection-specific coding and account notes for billing and follow-up communication.
Serves as primary liaison between faculty practice/department, insurance companies and patient to verify eligibility and coordination of benefits, and resolve any insurance complications.
High school graduate or GED certificate.
Good interpersonal, verbal, telephone and written communication skills in the English language.
Functional knowledge of basic computer operation and keyboard functions.
Must be a team player
Must possess outstanding customer service skills, compassionate, courteous and helpful manner.
Some knowledge of electronic billing systems.
Must be a motivated individual with a positive attitude and exceptional work ethic.
Minimum of 2 years of healthcare customer service experience
Knowledge of Medical Terminology, Diagnosis and Procedure coding.
Familiarity with gastroenterology procedures
Working knowledge of EPIC, Experian/MPV, IDX, Crown (EHR), Microsoft Word, and Excel.
Working experience of Managed Care Companies’ eligibility requirements and obtaining pre-authorizations.