Authorization Representative

3 weeks ago

Emeryville, California, United States IDR Healthcare Full time
Job Summary

IDR Healthcare is seeking a highly skilled Authorization Representative to join our team. As an Authorization Representative, you will play a critical role in ensuring seamless patient care by verifying patient eligibility, coordinating benefits, and obtaining necessary approvals.

Key Responsibilities
  • Eligibility Verification: Verify patient eligibility, coordinate benefits, ensure insurance coverage, and determine if prior authorization is needed. Document authorization details in the patient electronic medical record.
  • Authorization Process: Collect pertinent demographics and clinical data for authorization requests, contact insurance companies, and obtain necessary approvals. Enter authorization requests into the electronic health record.
  • Communication and Customer Service: Communicate with physicians, department staff, patients, and third-party payers to gather additional information and convey approvals, denials, or appeals. Provide excellent customer service by addressing concerns and resolving issues courteously.
  • Cross-Training and Support: Cross-train others to ensure consistent coverage and provide backup support as needed. Facilitate responses to patient inquiries regarding authorizations within turnaround standards.
Requirements
  • Education: High school diploma or equivalent education/experience.
  • Experience: 1 year of recent relevant experience in a similar role.
  • Skills and Knowledge: Proficiency in medical terminology, CPT/HCPCS/ICD-9 coding, and Microsoft Office programs (Excel, Word). Ability to exercise discretion and make independent judgments within established guidelines.
  • Communication and Organizational Skills: Strong interpersonal and active listening skills, excellent telephone communication, and organizational skills with attention to detail and follow-up. Ability to maintain composure during challenging interactions.
What We Offer
  • Competitive Compensation Package
  • Full Benefits: Medical, Vision, Dental, and more
  • Opportunity to Work with a Leading Healthcare Organization
  • Close-Knit and Team-Oriented Culture

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