Authorization Representative Wound and Plastic Surgery Clinic

Banner Health; Phoenix (AZ); On-site; USD 52,000 - 62,000; Full time

Job summary

Banner Health is seeking an Authorization Representative for the Wound and Plastic Surgery Clinic in Phoenix. The role focuses on obtaining pre-certifications for professional and medical services, verifying patient demographics and procedure codes, and communicating with physicians, patients and third-party payers.

This full-time daytime position emphasizes accuracy, efficiency and a high level of customer service.

Qualifications

• High school diploma or GED required.
• Experience in medical office or insurance environment preferred.
• Knowledge of managed care concepts and ICD-9/ CPT codes a plus.

Responsibilities

• Responds to referrals and obtains necessary authorizations from payors.
• Pre-certifies services and verifies patient demographics, codes and dates of service.
• Schedules appointments and answers questions about the authorization process.
• Provides information to physicians, patients and payers; assists with denials and appeals.
• Maintains documentation of all referral activity and authorizations.
• Works with staff on coordinating care within established guidelines.

Skills

Detail oriented

Flexible

Problem solver

Authorization experience

Customer service

Education

High school diploma/GED

Tools

Microsoft Office

Job description

## Authorization Representative Wound and Plastic Surgery ClinicApplylocations: BUMC Phoenix (1111 E McDowell Rd)time type: Full timeposted on: Posted Todayjob requisition id: R4450656**Primary City/State:**Phoenix, Arizona**Department Name:**BUMCP Plastic Surgery**Work Shift:**Day**Job Category:**Administrative ServicesThe 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**Location**: Banner Wound, Plastics, and Trauma Clinic – 1012 E Willetta St, Phoenix, AZ 85006This 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 MagnetTM 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 1. 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. 2. 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. 3. 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. 4. Documents and maintains records of all referral activity and authorizations. 5. Performs other related duties as assigned. This may include cross-coverage in other areas. 6. 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 QUALIFICATIONSOne 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.