Insurance Authorization Representative

2 weeks ago


West Allis, United States Infojini Full time
Job DescriptionJob Description

Below is the Job Description for your reference:

Title: Insurance Auth Representative

Location: Onsite: Home Care Divisional: 11333 West National Ave., West Allis WI 53227

Duration: 03+ months Contract with possibility of Extension

Shift timing: Mon to Fri - 8 am-4:30 pm w/ a 30 min lunch

Pay Rate:$28/hr on W2

Skills required:


Data entry position – will be working with an Excel spreadsheet to gather and transfer data to the UHC (United Healthcare) portal. Must be knowledgeable in Microsoft Office, especially Excel, and EPIC; will be processing around 55/day.


Must have a good attendance record


Technology/Equipment: EMR: EPIC – required; UHC Portal experience is a plus

 

Job Description:

Maintains, confirms, and secures referrals, authorization, or pre-certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information.
Maintains database of payer authorization requirements.

Major Responsibilities:
* Ensures information obtained is complete and accurate, applying acquired knowledge of
Medicare, Medicaid, and third-party payer requirements/online eligibility systems.
* Contacts insurance carriers to obtain benefit coverage, policy limitations,
authorization/notification, and patient pre-certifications. Follows up with physician offices, financial counselors, patients, and third-party payers to complete the pre-certification process,
* Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
* Educates patients, staff, and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance-related changes or trends.
* Ensures all services have prior authorizations and updates patients' preauthorization status. Coordinates peer-to-peer review if required by insurance.
* Notifies patient accounts staff/patients of insurance coverage lapses and self-pay patient status. May notify ordering providers if authorization/certification is denied.
* May coordinate scheduling of patient appointments, diagnostic and specialty
appointments, tests, and procedures.

* Maintains files for referral and insurance information, and enters referrals into the system.
« Maintains knowledge of and reference materials of the following: Medicare, Medicaid and
third-party payer requirements, guidelines, and policies, insurance plans requiring pre-authorization, and a list of current accepted insurance plans.

 

Education Required:

  • High School Graduate.

Experience Required:
Typically requires 1 year of experience in providing customer service that includes
experiences in patient accounts, third-party payer plans, accounts receivable/collection processes, and medical clinic processes and workflow.

Knowledge, Skills & Abilities Required:
* Knowledge of third-party payers and pre-authorization requirements,
* Understanding of basic human anatomy, medical terminology and procedures for application
in the patient referral/precertification/authorization processes.
Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic
mail, physician practice management, and electronic medical records systems.
Strong analytical, prioritization, and organizational skills.
* Ability to work independently with minimal supervision and to manage multiple priorities.
Exceptional communication and interpersonal skills with a high degree of diplomacy and tact. Ability to effectively communicate with a variety of people under stressful circumstances.

Physical Requirements and Working Conditions:

  • Exposed to a normal medical office environment.
  • Sits the majority of the workday.
  • Operates all equipment necessary to perform the job.


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