Authorization Representative

Jimmy Jazz; Harlan (IA); On-site; USD 35,000 - 60,000; Full time

Job summary

Jimmy Jazz in Harlan, IA seeks a Revenue Cycle Specialist responsible for managing authorizations, insurance verification, and referrals, ensuring visits are linked to referrals and proper billing.

You will schedule visits, assist with payer communications, prepare activity reports, and support financial advocates with estimates. Ideal candidates have 2+ years in healthcare Revenue Cycle and familiarity with CPT/ICD-10 coding.

Qualifications

• High school diploma or equivalent.
• Associates degree in finance or medical office assistant or CMA, LPN or RN preferred.
• Two years of related healthcare Revenue Cycle experience.
• Understanding of medical terminology and clinical documentation.
• Knowledge of CPT, ICD10, HCPCS coding.
• Proficiency with MS Office tools and general computer skills.

Responsibilities

• Obtain authorization for procedures or services requiring prior authorization.
• Notify Nurse Navigator of authorization requirements.
• Create payer listings, contact information, and requirements.
• Assist with identifying departmental procedures and authorization requirements.
• Communicate with providers when requirements change.
• Assist financial advocates with estimates for services and patient communications.
• Coordinate with departments to promote understanding of Referral/Authorization/Verification.

Skills

Revenue Cycle experience

Customer service

Medical terminology

MS Office

Insurance verification

Prior authorization

Education

Associate degree in finance or medical office assistant

CMA/LPN/RN preferred

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

• Location 1213 GARFIELD AVE,Harlan, IA, 51537-2071,United States
• Job Category Non-Clinical
• Employee Type Non-Exempt Full-time

Contact information

Description

SCHEDULE: Full-time; 36 hours per week; 4 days per week; Monday, Tuesday, Thursday, Friday; 7:00 am - 4:30 pm

Responsible for maintaining referral and authorization records, obtaining authorizations, scheduling visits and ensures all visits are linked to referrals as required by insurance companies and the electronic health record. Assists with "on the fly" authorizations for services that are changed at time of service. Contacts patients for updated insurance information, where applicable and coordinates with the financial advocates when needed for all patients, including self-pay or out of network estimates. Prepares reports of activity as requested by management. Performs financial reviews and calculations based upon information received from the insurance company, assists with logistical and/or clerical problem resolution related to the patient's medical record, authorization and billing issues.

Requirements

High school diploma or equivalent required. Associates degree in finance or medical office assistant or CMA, LPN or RN preferred. Two years of related healthcare Revenue Cycle experience, preferably within billing and/or coding or clinical experience. Understanding of medical terminology and clinical documentation. Clear understanding of the impact insurance verification and prior authorization have on Revenue Cycle operations and financial performance. Demonstrated knowledge of insurance carriers' guidelines and criteria of verification, authorization and reimbursement, as well as website navigation. Understanding of coding (CPT, ICD10, HCPCS). Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers. Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment. Ability to prioritize and effectively anticipate and respond to issues as they arise. A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Word, Excel) as necessary; general computer skills necessary to work effectively in an office environment.

Summary

Obtains authorization from payers for any procedure or service requiring prior authorization. Notifies Nurse Navigator of authorization requirements as discovered from payers. Creates list of authorization methods - phone or web-based. Creates payer listing, contact information, requirements. Assists with identifying departmental procedures and authorization requirements. Identifies and communicates with providers when authorization requirements change. New payer plan review, evaluation and research of authorization requirements alongside Nurse Navigator. Assists financial advocates with calculation of estimates for services and communication with patient. Provides authorization assistance to department staff when the procedure performed is different from the procedure authorized. Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral and Insurance Verification requirements and processes. Communicates efficiently, effectively and timely to resolve issues pertaining to the verification and authorization processes. Schedules visits: Infusion Center, Surgical Clinic, Surgery and other hospital services areas as determined. Note: this is a partial listing of key job areas. For a complete job description, contact HR.