Authorization Representative
Orthoeast, Greenville, NC, United States
Job Title:
Authorization Representative
Department:
Clinical Support
Reports To:
Clinic Support Supervisor
FLSA Status:
Non-exempt (hourly)
Work Schedule:
Monday-Friday, 8:00 A.M. - 5:00 P.M.
Summary
Secure pre‑authorization for patients for MRI, PT, injections, in‑house procedures and surgeries. Must also support obtaining pre‑authorizations for urgent or special surgical cases.
This position requires compliance with OrthoEast’s compliance standards, including its Code of Conduct, Compliance Program, and policies and procedures. Such compliance will be an element required as part of the job duties and considered during performance evaluations.
Full‑time position requiring consistent attendance, punctuality, and adherence to the above work schedule.
Essential Duties and Responsibilities
Verify Insurance Coverage: review and verify insurance information provided by patients to ensure coverage for medical procedures, treatments, or services.
Obtain Prior Authorizations: communicate with insurance companies and other relevant parties to obtain necessary prior authorizations for medical procedures or treatments as required.
Documentation and Record‑Keeping: maintain accurate, up‑to‑date records of authorization requests, approvals, and denials; ensure all documentation is complete, organized, and compliant with regulations.
Communication with Healthcare Providers: collaborate with physicians, nurses, and medical staff to gather necessary information for authorization requests and resolve any issues or discrepancies.
Patient Education: inform and educate patients about their insurance coverage, authorization requirements, and any financial responsibilities related to their medical services.
Insurance Claims Management: assist in the claims process by ensuring proper authorization documentation is submitted and follow up on any pending claims or denials related to authorizations.
Compliance with Regulations: stay updated on healthcare regulations, insurance policies, and industry changes to ensure compliance in all authorization activities.
Problem‑Solving and Troubleshooting: proactively identify and resolve authorization‑related issues, including denials or delays, by collaborating with insurance companies, patients, and providers.
Customer Service: provide excellent customer service to patients, insurance companies, and providers by promptly addressing inquiries, concerns, and requests related to authorizations.
Process Improvement: identify opportunities for process improvement in the authorization workflow, such as streamlining procedures or implementing new technologies, to enhance efficiency and accuracy.
Other duties as assigned.
Qualifications
High School diploma or GED required.
Minimum of one year authorization experience preferred.
Minimum of one year clerical experience, preferably in a medical office setting, required.
Proficient computer skills required, including Excel, Word, and Outlook.
Experience in maintaining confidentiality when dealing with sensitive issues.
Proven ability to make sound and accurate judgments in problem‑solving work issues.
Successful record of follow‑through on commitments and demonstrated dependability.
Required Behaviors
The physical demands of this position require long periods of sitting, keyboarding, and talking on the telephone.
Good communication skills are required when dealing with a diverse patient population, often concerning stressful and/or emotional situations.
Ability to prioritize tasks and work independently.
Ability to handle frequent change, delays, and/or unexpected events.
Must be willing to work in a team environment and contribute to building a positive team spirit.
Must be highly organized to manage multiple tasks simultaneously.
Must be able to stay focused during work periods of high patient volume.
Exhibit pleasant, professional telephone etiquette at all times.
#J-18808-Ljbffr
Authorization Representative
Department:
Clinical Support
Reports To:
Clinic Support Supervisor
FLSA Status:
Non-exempt (hourly)
Work Schedule:
Monday-Friday, 8:00 A.M. - 5:00 P.M.
Summary
Secure pre‑authorization for patients for MRI, PT, injections, in‑house procedures and surgeries. Must also support obtaining pre‑authorizations for urgent or special surgical cases.
This position requires compliance with OrthoEast’s compliance standards, including its Code of Conduct, Compliance Program, and policies and procedures. Such compliance will be an element required as part of the job duties and considered during performance evaluations.
Full‑time position requiring consistent attendance, punctuality, and adherence to the above work schedule.
Essential Duties and Responsibilities
Verify Insurance Coverage: review and verify insurance information provided by patients to ensure coverage for medical procedures, treatments, or services.
Obtain Prior Authorizations: communicate with insurance companies and other relevant parties to obtain necessary prior authorizations for medical procedures or treatments as required.
Documentation and Record‑Keeping: maintain accurate, up‑to‑date records of authorization requests, approvals, and denials; ensure all documentation is complete, organized, and compliant with regulations.
Communication with Healthcare Providers: collaborate with physicians, nurses, and medical staff to gather necessary information for authorization requests and resolve any issues or discrepancies.
Patient Education: inform and educate patients about their insurance coverage, authorization requirements, and any financial responsibilities related to their medical services.
Insurance Claims Management: assist in the claims process by ensuring proper authorization documentation is submitted and follow up on any pending claims or denials related to authorizations.
Compliance with Regulations: stay updated on healthcare regulations, insurance policies, and industry changes to ensure compliance in all authorization activities.
Problem‑Solving and Troubleshooting: proactively identify and resolve authorization‑related issues, including denials or delays, by collaborating with insurance companies, patients, and providers.
Customer Service: provide excellent customer service to patients, insurance companies, and providers by promptly addressing inquiries, concerns, and requests related to authorizations.
Process Improvement: identify opportunities for process improvement in the authorization workflow, such as streamlining procedures or implementing new technologies, to enhance efficiency and accuracy.
Other duties as assigned.
Qualifications
High School diploma or GED required.
Minimum of one year authorization experience preferred.
Minimum of one year clerical experience, preferably in a medical office setting, required.
Proficient computer skills required, including Excel, Word, and Outlook.
Experience in maintaining confidentiality when dealing with sensitive issues.
Proven ability to make sound and accurate judgments in problem‑solving work issues.
Successful record of follow‑through on commitments and demonstrated dependability.
Required Behaviors
The physical demands of this position require long periods of sitting, keyboarding, and talking on the telephone.
Good communication skills are required when dealing with a diverse patient population, often concerning stressful and/or emotional situations.
Ability to prioritize tasks and work independently.
Ability to handle frequent change, delays, and/or unexpected events.
Must be willing to work in a team environment and contribute to building a positive team spirit.
Must be highly organized to manage multiple tasks simultaneously.
Must be able to stay focused during work periods of high patient volume.
Exhibit pleasant, professional telephone etiquette at all times.
#J-18808-Ljbffr