Authorization Rep

Job title: Authorization Rep

Location: Las Vegas, NV, 89113

Duration: 7 Month contract

Summary

Job Summary:

• This position is responsible to obtain insurance eligibility and benefits information and obtain required authorizations.
• Reviews all insurance eligibility responses and communicates with the physician's office and insurance companies as needed regarding these responses or to obtain correct information.
• Works with Utilization Review staff to ensure authorizations cover services needed. May also estimate cost of service and patient's responsibility.
• Refers patients with questionable insurance coverage to the Eligibility Counselors. May assist in mentoring new hires

Job Duties:

• Obtains insurance eligibility and benefit information using various phone and on-line resources.
• Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.
• Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe.
• Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement.
• Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.
• Immediately refers "at risk" admission to eligibility, i.e., out of network, underinsured, max benefits, etc.
• Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays.
• Maintains a satisfactory level of performance and adherence to workload standards.
• Estimates cost of service using ICD-9 or CPT codes.
• Performs calculations using insurance benefit information to accurately estimate patient responsibility.
• May lead and/or train new employees in account preparation and review functions

Required Qualifications

• Two years of customer service experience.
• Demonstrated good communications and computer skills.
  Physical Requirements:
• Interact with others requiring the employee to communicate information.
• Operate computers and other office equipment requiring the ability to move fingers and hands.
• See and read computer monitors and documents.
• Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Preferred Qualifications

• Demonstrated knowledge of medical terminology.
• Experience in admitting, billing, collections, and/or insurance verification.
• Bi-Lingual Spanish speaking.
• Demonstrated knowledge of CPT/ICD-9 codes.

Required Educations:

HS Diploma or GED