Authorization Representative - LSU Perkins

Franciscan Missionaries of Our Lady Health System Inc; Baton Rouge (LA); On-site; USD 35,000 - 50,000; Full time

Job summary

Franciscan Missionaries of Our Lady Health System Inc is seeking an Authorization Representative in Baton Rouge, LA. The role involves ensuring that patients are cleared for their hospital services, addressing pre-certification issues, and managing insurance and patient information to guarantee quality care. Candidates should have at least 1 year of experience in a medical office setting and a high school diploma.

This full-time position offers a consistent schedule from Monday to Friday, 8:00 AM to 4:30 PM, with responsibilities focused on patient access and authorization processes.

Qualifications

• 1 year experience in medical office or hospital setting.

Responsibilities

• Ensure patients have been cleared for hospital services.
• Resolve pre-certification and case-related concerns.
• Process referrals to specialists and hospitals efficiently.
• Verify insurance and document authorization status.

Skills

Basic clerical skills

Basic computer skills

Education

High School or equivalent

Job description

Job Description

The Authorization Rep ensures patients have been cleared for Hospital services, specialty service and office visits. Resolves pre-certification, registration and case-related concerns and determination of patient finanical obligation prior to a patient's service or visit. Works with insurance carriers, financial counselors, specialists and other ancillary staff. Also responsible for accurately validating patient information and ensuring the patient's experience is best in class. Relies on guidelines to accomplish tasks. Relies on experience and judgment to complete job. Works under general supervision.

Responsibilities

• Customer Service
• Gathers information from the chart and clinic personnel regarding insurance coverage and reason for the procedure.
• Gathers information from the chart and clinic personnel regarding insurance coverage and reason for the procedure.
• Relays authorization approval, peer to peer request or denial status to the clinic personnel and physician timely to facilitate patient care.
• Accurately and efficiently processes referrals to specialists, hospitals and diagnostic centers in accordance with physician orders processing referrals in a timely manner for required services in the most appropriate setting; coordinates the referrals with insurance providers so that financial liability to the patient is minimized.
• Obtains/scans outside clinic records after patient appointment with specialist to assure continuity of care.
• Quality
• Utilizes available resources to determine if physician is participating with patients' insurance plan. Ensures lists of doctors and needed items are updated and modified as necessary.
• Attends meetings as required and participates on committees as directed. Strives to improve the quality of meeting by taking an active role in meeting topics.
• Assures that authorizations are obtained prior to date of service for 99 % of cases scheduled.
• Schedules are reviewed prior to date of service to assure that authorization numbers have been obtained for all procedures that require one.
• Scans authorization confirmation/denials into chart in a timely manner to facilitate claims processing should issues arise.
• Responsible for the verification of insurance information, as well as documenting the need for authorization or lack of need for authorization in the computer system to facilitate claims processing.
• Contacts insurance carriers to secure authorization information. Documents authorization information in the computer system to ensure visits are approved.
• Acts as a resource for the department personnel as it relates to the authorization process and documentation required for services.
• Other Duties as Assigned: Performs other duties as assigned or requested.

Qualifications

Experience: 1 year experience in medical office or hospital setting

Education: High School or equivalent

Special Skills: Basic clerical and computer skills

• Job Identification 48136
• Job Category Revenue_Cycle
• Degree Level High School Graduate
• Job Shift Day
• Job Function Patient Access
• Worker Type Employee
• Regular or Temporary Regular
• Requisition Schedule Full-Time
• Hours of Schedule (e.g. M-F 8a-5p) M-F 8am-4:30p
• FMOLHS Company Code Our Lady of the Lake Hospital Inc