Pre-Authorization Representitive

Penrose Hospital; United States; Sur place; USD 40 000 - 60 000; Plein temps

Résumé du poste

Penrose Cardiology Clinic in Colorado Springs is seeking a Pre-Authorization Representative to ensure financial access to care by verifying insurance coverage and securing required authorizations for procedures and visits.

You will document approvals in hospital systems, liaise between patients, physicians, the radiation oncology admin, and billing staff, and uphold accuracy and efficiency in all transactions.

Qualifications

• High school diploma or GED required.
• Two years experience in outpatient clinic or health care setting.
• Strong understanding of insurance processes.
• Exceptional attention to detail and organizational skills.
• Effective communication with patients, physicians, and staff.

Responsabilités

• Conducts thorough eligibility checks for all patient types using various verification tools.
• Initiates, obtains, and documents all necessary preauthorizations within the Clinical Information System.
• Compiles CPT codes to assist financial counselors with patient cost estimates.
• Serves as a backup for exporting charges to the hospital billing system and resolves discrepancies.
• Maintains knowledge of insurance regulations and reimbursement policies.
• Provides cross-functional coverage to ensure departmental efficiency.

Connaissances

Insurance verification

Preauthorization processing

Communication skills

Organizational skills

Attention to detail

Formation

High School Diploma/G.E.D.

Outils

Clinical Information System

Description du poste

Where You'll Work

Penrose Cardiology Clinic

2222 North Nevada Avenue

Suite 510

Colorado Springs, CO 80907

CommonSpirit Medical Group (CMG) offers providers a true opportunity to live their calling to care while experiencing the support of a built-in comprehensive network, vast resources, professional growth, trusted leadership, generous benefits and an amazing quality of life with locations in Colorado, Kansas and Utah. CMG is proud to connect providers and consumers through state-of-the-art technology, clinical resources and professional expertise to help people live healthier. Our coordinated services represent a full continuum of care - from preventive and early diagnoses to leading-edge treatment and life-saving critical care. CMG's ability to deliver better health care value is the direct result of combining the best clinical tools, shared resources and medical expertise with a patient-centered approach that emphasizes CommonSpirit Mountain Region's mission and commitment to quality, compassion and service.

Job Summary and Responsibilities

As our Pre-Authorization Representative, you will play a critical role in ensuring financial access to care by verifying insurance coverage and expertly obtaining all necessary authorizations and pre-certifications for ordered procedures and office visits. Every day you will utilize scheduling and registration information to verify patient benefits, secure required authorizations from insurance carriers or third-party vendors, meticulously document all approvals in hospital systems, and act as a vital liaison between patients, physicians, Radiation Oncology Administration, the centralized billing office, and community agencies. To be successful in this role, you will possess exceptional organizational skills, a meticulous attention to detail in verifying coverage and obtaining authorizations, strong communication abilities, and a deep understanding of insurance processes to ensure seamless patient access to care and efficient billing.

• Conducts thorough eligibility checks for all patient types using various electronic and telephonic verification tools to ensure accurate coverage data.
• Initiates, obtains, and documents all necessary preauthorizations within the Clinical Information System while escalating issues to the administration team.
• Compiles CPT codes based on treatment prescriptions to assist financial counselors with patient cost estimates and self-pay financial assistance screening.
• Serves as a backup for exporting charges to the hospital billing system, ensuring all data is linked to the correct account numbers and resolving discrepancies.
• Maintains current knowledge of insurance regulations and reimbursement policies by attending meetings and participating in ongoing educational sessions.
• Maintains cross-functional competency by participating in team training and providing coverage for other administrative roles to ensure departmental efficiency.

Job Requirements

Required

High School Diploma/G.E.D.

Two (2) years experience in outpatient clinic, physician office or other health care setting