Prior Authorization Representative

3 weeks ago

Columbus Ohio, United States Ohio State University Physicians, Inc. Full time
Overview:
Looking to join our dynamic team at Ohio State University Physicians where excellence meets compassion?

 

Who we are

With over 100 cutting-edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part. As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth.

 

Our culture

At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community.

 

Our benefits

We know that having options and robust benefit plans are important to you. OSUP prioritizes the wellbeing of our team and that’s why we offer our employees a flexible, competitive benefit package. In addition to medical, dental, vision, health reimbursement accounts, flexible spending accounts, and retirement, we also offer an employee assistance program, paid time off, holidays, and a wellness program designed to support our employees so they can live their best lives.

 

Responsibilities:
Uses integrated health information systems and telephone technology with customer service skills to facilitate customer interactions such that the customer experiences the Medical Center and its entities as an accessible, coordinated, and seamless entity.

 Performs an accurate search for patient in EPIC data base, thus, reducing the number of duplicate patient records. Assesses the patient’s financial ability to pay for services, referring patients to financial counseling staff when appropriate.

Sends eligibility requests to all payors to verify accurate and current coverage.

Provides required clinical, insurance, and demographic information to payor to obtain precertification. Verifies insurance eligibility via various tools. Requests and creates referrals for specified population, as required.

Pre-certifies and obtains authorization numbers and enters information into patient’s account obtaining medical, ICD and CPT codes.

Contacts external companies to verify patient’s employment and insurance information for Workers compensation cases, as required.

Works with the Veterans’ Administration to assure services are covered and authorized.

Provides accurate information to billing and case management to assure payment of claims.

Interacts and maintains excellent working relationships with medical staff, referring physicians, and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement.

Displays the highest level of customer service, attentiveness, and consideration possible in all cases, keeping within the standard set by the Office of Compliance and HIPAA in reference to confidentiality.

Alerts management of problems with systems and workflow.

The ability to perform the duties of FCR Pre-Reg and to assist that area as assigned.

Other duties as assigned.

Qualifications:
Associates degree or higher, or high school diploma/GED with 2+ years of experience in insurance, healthcare, or related field.

Excellent customer service skills coupled with enthusiasm and compassion along with the ability to work in a fast paced environment.

Exceptional verbal and written communication skills.

High level of interpersonal skills to handle sensitive, confidential situations and establish effective working relationships with patients, physicians, team members, and others throughout the organization.

Attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with physicians, co-workers and supervisors, and politeness to customers, vendors, and patients.

Ability to escalate issues if necessary.

Knowledge and understanding of coding, insurance, and Federal, State, and 3rd party billing/reimbursement requirements.

Experience with PC applications including MS Office and Internet.

Ability to maintain employer training requirements.

Pay Range:
USD $17.06 - USD $25.59 /Hr.

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