What are the responsibilities and job description for the Authorization & Eligibility Representative (FT) position at Ashe Memorial Hospital?
At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care."
Ashe Memorial Hospital is proud to be Voted Ashe's Best Place to Work 2022 & 2023! Come be a part of our dynamic team; you'll join Ashe's 2022 & 2023 Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice! This is your opportunity to make a large difference in a small community!
Hours: 1st shift, Monday - Friday | No Supervisory Responsibilities | No Travel | Pay commensurate with experience
Full Time, 40 hour, day shift position in Scheduling.
JOB SUMMARY: Under general supervision, responsible for obtaining and validating prior authorization for scheduled services as dictated by Payer guidelines prior to the patient’s appointment time. Communicates directly with the patients and referring physicians to obtain appropriate insurance and clinical information required to solicit authorization from the designated utilization management company.
Minimum Job Qualifications:
Education: High school diploma or GED.
Experience: One year of experience of working in the healthcare industry preferred; previous experience in obtaining insurance authorizations preferred.
Licenses/Certifications: None.
ESSENTIAL FUNCTIONS:
- Utilizes work list to contact appropriate utilization management company or insurance payer to request authorization where company can obtain.
- Sends timely requests to referring physicians for authorization numbers where company cannot obtain.
- Communicates authorization cases denied for medical necessity or requiring peer to peer review to the referring physician for resolution.
- Validates all authorizations for accuracy prior to exam.
- Follows up on all pending authorizations with the appropriate entity. Forward correspondence to offices for exams on their daily schedule.
- Documents authorization in scheduling system according to defined protocol.
- Answers incoming calls from offices, referring physicians and patients regarding authorization requirements and status.
- Answers incoming calls from patients to provide an estimate of our of pocket cost after insurance processing prior to exam.
- Arranges appropriate date/time based on patient needs and exam being scheduled when patient calling for price quote elects to have procedure performed.
- Responsible for contacting patients directly to reschedule the exam if authorization is not obtained prior to appointment time.
- Executes eligibility searches using available applications.
- Researches eligibility exceptions to locate missing information or determine if there is an absence of coverage.
- Provides excellent customer service with all customers
- Adheres to referring physician requested protocol regarding authorization requests.
Must be willing to receive all required vaccinations (i.e., flu shot, etc.). All new employees working must be fully vaccinated as a condition of employment (unless the new hire has requested and received an exemption). Candidates for employment will be notified of this policy requirement prior to the start of employment. After receiving an offer of employment, new employees must provide proof of vaccination or request and receive an exemption before beginning work.
To apply, please fill out an application, attach a cover letter, and resume. Include gaps in employment and reasons for separation.
Criminal background check and pre-employment drug screen required upon conditional job offer.
***Benefits apply the 1st of the month following employment, per policy.***
*For full job description and benefits, please contact Human Resources.
Ashe Memorial Hospital is an equal opportunity employer and, as such, considers individuals for employment according to their abilities and performance. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care. Employment decisions are made without regard to race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, genetic information, or any other classification protected by law. All employment requirements mandated by local, state, and federal regulations will be observed.
