Prior Authorization Representative

Patient Prior Authorization Specialist

Responsible for patient prior authorization, patient referrals including scheduling of internal referral and outgoing patient referrals, documentation of status of prior authorizations and referrals, ability to navigate registration, referral entries, auth/cert entries and patient chart workflows in EPIC, ability to update and confirm current patient insurance coverage and day to day monitoring of all EPIC prior authorizations and referrals work queues. Principal Accountabilities Standards of Performance: Respect, Integrity, Compassion, Collaboration, Stewardship, Accountability, Quality Education High School diploma or equivalent Licenses and Certification N/A Experience and Skills Technical Experience: 1 to 3 years of office experience required and 1 year EMR experience preferred. Effective and excellent communication skills. Physical Activities Intermittent hand manipulation required Intermittent lifting and carrying of 20 pounds Role Specific Responsibilities Monitors EPIC prior authorization and referrals work queues daily Classified insurance approvals, based on physician orders, in order to expedite claim processing. Identify and prioritize urgent and emergency prior authorizations and referral consultation requests Checks chart for relevant referral/prior authorization information and shares with appropriate insurance provider or referring office provider Call or submit online request to insurance providers for prior authorizations Communicates details regarding denials and peer-to-peer request for prior authorizations and provider offices Communicates effectively with patients, provider staff and insurance providers by telephone and Epic Inbasket Follow through on referrals and prior authorizations to completion/resolution in a timely fashion Document progress/status of prior authorizations and referrals on the EPIC referral or EPIC auth/cert forms Follow-up on missing insurance documentation with patients Schedules internal referrals in EPIC directly onto the provider's schedule. Validates information for a prior authorization or referral request and follows-up with providers office regarding missing CPT codes or missing chart documentation Collaborates with staff to identify workflow problems and identify solutions Consistently looks for ways to streamline the prior authorization and referrals process and improve the patient and staff experience Leads, tracks, monitors updates in insurance prior authorization criteria and educate provider staff Compensation (Commensurate with experience): $16.56 - $24.84 To access our Benefits Guide/Plan Information, please click the link below: http://www.sih.net/careers/benefits