What are the responsibilities and job description for the Insurance Authorization Representative, Advocate Aurora Continuing Health position at Advocate Aurora Health?
Department :
10429 Home Office WI - Insurance Verification
Status : Full time
Benefits Eligible : Hou rs Per Week :
Schedule Details / Additional Information :
Monday - Friday 8 hours daily 8 : 30am - 5 pm
Onboarding / online orientation - two day in-office commitment
Maintains, confirms and secures referrals, authorization, or pre-certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information. Maintains database of payer authorization requirements.
Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements / on-line eligibility systems.
Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization / notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.
Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
Notifies patient accounts staff / patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization / certification is denied.
May coordinate scheduling of patient appointments, diagnostic and / or specialty appointments, tests and / or procedures.
Maintains files for referral and insurance information, and enters referrals into the system.
Maintains knowledge of and reference materials of the following : Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
Scheduled Hours
Monday - Friday, 8 hours daily 8am or 8 : 30am start.
Licenses & Certifications
None Required.
Degrees
High School Graduate.
Required Functional Experience
Typically requires 1 year of experience in providing customer service that includes experiences in patient accounts, third- party payer plans, accounts receivable / collection processes, and medical clinic processes and workflow.
Knowledge, Skills & Abilities
Knowledge of third-party payers and pre-authorization requirements.Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / pre-certification / authorization processes.Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, physician practice management, and electronic medical records systems.Strong analytical, prioritization and organizational skills.Ability to work independently with minimal supervision and to manage multiple priorities.Exceptional communication and interpersonal skills with a high degree of diplomacy and tact. Ability to effectively communicate with a variety of people under stressful circumstances.
Pay Range
20.40 - $30.60
Our Commitment to You :
Advocate Health offers a comprehensive suite of Total Rewards : benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including :
Compensation
- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and / or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
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