Authorization Representative Wound and Plastic Surgery Clinic

bannerhealth; Phoenix (AZ); On-site; USD 42,000 - 56,000; Full time

Job summary

Banner Health in Phoenix, AZ, is seeking an Administrative Services professional to obtain and process clinical information needed for professional and medical service authorization. You will respond to patient referrals and collaborate with insurance payors to pre-certify services based on the patient’s benefit plan.

The role requires strong problem-solving and multi-tasking abilities, with emphasis on accuracy, good communication, and the ability to work with a multidisciplinary team in a

Qualifications

• Must have effective verbal and written communication skills.
• Proficient with commonly used office software.

Responsibilities

• Responds to patient referrals for tests, procedures and visits; handles authorizations required by payors and verifies patient information.
• Re-certifies services when necessary and communicates authorization numbers to relevant staff.
• Authorizes and schedules appointments; answers questions about the authorization process for physicians, patients and payers.
• Maintains records of all referral activity and authorizations; supports cross-coverage as needed.
• Works with patients and staff to resolve eligibility issues and denials and appeals.

Skills

Verbal & written communication

MS Office proficiency

Education

High school diploma/GED

Tools

MS Office Suite

Job description

Primary City/State: Phoenix, Arizona

Department Name: BUMCP Plastic Surgery

Work Shift: Day

Job Category: Administrative Services

The academic medicine difference. At the center of Banner – University Medicine is patient care, research, and teaching. Join a nationally recognized health care leader and experience the future of medicine today.

Banner – University Medical Center Wound Care and Hyperbaric Medicine Clinic is part of the Wound Care & Hyperbaric Medicine Center at Banner – University Medical Center Phoenix. The clinic offers treatment options for patients with complicated, chronic and non-healing wounds. Our multi-disciplinary team, which includes family practice physicians, plastic surgeons, podiatrists, vascular surgeons, general surgeons and orthopedic surgeons, all have advanced training in wound care. Our clinicians have national certification and expertise in caring for patients with wounds. We use a case management model to help patients navigate through the complex health care arena

This is a full time (40 hours/week), day shift position: Monday - Friday, 7:30am-4pm. Perfect for detail oriented, flexible, problem solver with strong authorization experience, customer service skills and ability to multi-task with a positive demeanor.We are a very hard working and competent group. We provide lots of hands on training on a continual basis. Our clinic allows for staff to learn a ton about all aspects of this clinic- clinical, data driven info, etc.

University Medical Center Phoenix is a nationally recognized academic medical center. The world-class hospital is focused on coordinated clinical care, expanded research activities and nurturing future generations of highly trained medical professionals. Our commitment to nursing excellence has enabled us to achieve Magnet™ recognition by the American Nurses Credentialing Center. The Phoenix campus, long known for excellent patient care, has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona College of Medicine - Phoenix. Additionally, the campus responsibilities include fully integrated multi-specialty and sub-specialty clinics and has operations in multiple locations spanning across the Phoenix metropolitan city.

Position Summary

This position is responsible for obtaining and processing all pertinent clinical information needed for the authorization of professional and medical services. The position responds to patient referrals and works insurance companies to pre-certify services based on the patient’s benefit plan.

Core Functions

• Responds to patient referrals for tests, procedures, and specialty visits. Obtains authorizations required by various payors; including verification of patient demographic information, codes, dates of service, and clinical data. Re-certifies services when necessary.
• Authorizes and schedules appointments. Answers questions regarding the authorization process and supplies information to physicians, patients, and third party payers. May, depending on department/location, inform patients about necessary preparation for procedure or test.
• Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing. Provides information about the referral process to physician and staff and informs them of eligibility issues. Works with staff and patients regarding denials and appeals.
• Documents and maintains records of all referral activity and authorizations.
• Performs other related duties as assigned. This may include cross-coverage in other areas.
• This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision.

Minimum Qualifications

• High school diploma/GED or equivalent working knowledge.
• Must possess effective verbal and written communication skills.
• Must be proficient with commonly used office software.

Preferred Qualifications

• One or more years of experience normally gained in a medical office or insurance environment. Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD9 and CPT codes.
• Additional related education and/or experience preferred.

EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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