Authorizations-Insurance Rep

4 weeks ago

Phoenix, United States Phoenix Children’s Full time

Position Summary

This position ensures all inpatient/observation stay authorizations and/or referral numbers are present in the AMPFM system for discharged patients at the Hospital. This position also obtains valid inpatient / observation authorization numbers and/or referral numbers for approved Length of Stay (LOS) and Tier Level of Care (LOC) at point of discharge.

Position Duties

Collaborates with all Admitting financial services personnel to ensure that a continuum of performance exists between account activation and final discharge status. Ensures appropriate follow up actions are consistent with departmental standards to find, troubleshoot, and resolve any missing authorizations on discharged patients. Works collaboratively with Admitting management and senior personnel in researching denials that are due to no authorization. Establishes and maintains a multi-tasking mentality in an effort to produce consistently throughout an eight-hour period each day. Identifies and conveys service dates from point of presentation to discharge towards third party payors with an emphasis on acquiring accurate authorization numbers. Identifies and conveys Tier levels of care to all AHCCCS plans, commercial carriers, and out of state plans to secure authorizations for services rendered at PCH. Obtains retro authorizations when research and discovery produce data absence relative to discharged patient accounts. Reviews and processes daily discharged patient report to ensure accurate and valid authorization/referral numbers are obtained and posted correctly into the AMPFM benefits and authorization screens. Updates and denotes account activity on a daily basis for all discharged accounts. Uses sound judgment and analytical skills to ensure positive financial outcomes on all assigned accounts. Uses system-generated reports to view, inspect, and resolve accounts as they become available on a daily basis. Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

Offering the most comprehensive care across ages, communities and specialties Investing in innovative research, including emerging treatments, tools and technologies Advancing education and training to shape the next generation of clinical leaders Advocating for the health and well-being of children and families Values We place children and families at the center of all we do We deliver exceptional care, every day and in every way We collaborate with colleagues, partners and communities to amplify our impact We set the standards of pediatric healthcare today, and innovate for the future We are accountable for making the highest quality care accessible and affordable

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