Medical Authorization Support Representative
5 days ago
Estimated Salary: $60,000 - $70,000 per year
About Us: At Fallon Health, we prioritize our members' needs and strive to provide equitable, high-quality care. Our team is dedicated to delivering exceptional service and support to our patients and providers.
Job Description:
- We are seeking a highly skilled Medical Authorization Support Representative to join our team. The successful candidate will work closely with our authorization coordinators to ensure timely and accurate processing of medical authorizations.
- As a Medical Authorization Support Representative, you will be responsible for communicating with contracted and non-contracted facilities/agencies/providers to collect pertinent data regarding an episode of care.
- You will also be handling incoming calls from multiple ACD lines, addressing customer inquiries, and providing direction regarding plan policies and procedures.
- The ideal candidate will have excellent communication and problem-solving skills, with the ability to maintain high levels of confidentiality and professionalism.
Key Responsibilities:
- Communicates with contracted and non-contracted facilities/agencies/providers to collect pertinent data regarding an episode of care.
- Updates authorization information in QNXT as a result of determinations made by Authorization Coordinators, Nurse Reviewers, and/or Nurse Care Specialists.
- Handles an appropriately high volume of daily auth entries into the core system (QNXT).
- Generates notifications to members, facilities, and agencies according to established protocol.
- Interfaces with other FCHP departments to obtain and verify information relevant to pre-authorization requests.
Qualifications:
- Bachelor's degree or equivalent experience in healthcare administration or a related field.
- At least 2 years of experience in a managed healthcare environment, preferably in a call center setting.
- Excellent communication, problem-solving, and time management skills.
- Able to maintain high levels of confidentiality and professionalism.
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