Patient Access Services Authorization Representative Monday-Thursday 9AM-5:30PM

Primary City/State:

Department Name:

Work Shift:

Job Category:

POSITION SUMMARY

This position performs insurance verification and authorization functions that support Patient Access Services and ensures compliance with both department standards and billing requirements. This position requires the ability to retain large amounts of changing payor information/knowledge crucial to attaining reimbursement for the services provided. This position is expected to reduce authorization-related initial denials/write-offs.

CORE FUNCTIONS

1. Uses department procedures and new hire training to accurately complete authorization initiation requests with payers for all service lines and validates existing authorizations requested by providers. Completes authorization initiation for acute and ambulatory visits. Utilizes standard authorization submission tools, websites, and documents authorization updates in Host systems.

2. Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing. Provides information about the referral process to physician and staff. Documents and maintains records of all referral activity and authorizations in appropriate Host fields. Refers encounters for peer review to substantiate ordered procedures.

3. Responds to “provider orders” for tests, procedures, and specialty visits. Obtains authorizations for single and/or reoccurring visits required by various payers, including verification of patient demographic information, codes, dates of service, and clinical data. Representatives will stay current on payor requirements and utilization of third-party authorization submission software to complete authorizations.

4. Works independently from a remote location and follows structured work routines. Works in a fast-paced environment requiring independent decision making and sound judgment to prioritize work and ensure appropriateness and timeliness of each patient’s care.

5. Follows escalation protocols for accounts not meeting authorization standards by working with the ordering provider, scheduling departments, PAS leaders, and administrative groups for resolution in all acute, ambulatory, Banner Imaging, and Oncology service lines.

6. Performs other related duties as assigned. This may include cross-coverage in other authorization-related areas.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.

SUPERVISORY RESPONSIBILITIES

DIRECTLY REPORTING

None

MATRIX OR INDIRECT REPORTING

None

TYPE OF SUPERVISORY RESPONSIBILITIES

None

Banner Health Leadership will strive to uphold the mission, values, and purpose of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner.

PHYSICAL DEMANDS/ENVIRONMENT FACTORS

OE - Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager)

Requires extensive sitting with periodic standing and walking.

May be required to lift up to 20 pounds.

Requires significant use of personal computer, phone and general office equipment.

Needs adequate visual acuity, ability to grasp and handle objects.

Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.

May require off-site travel.

Remote/Work From Home.

May require video conferencing.

MINIMUM QUALIFICATIONS

High school diploma/GED is required.

Requires minimum of three years of experience in healthcare insurance and/or authorizations.

Certification for CRCR required within one year of hire.

Business skills and experience in the assigned work area are required. Must be detail oriented. Must be able to maintain high productivity standard with minimal errors. Advanced abilities in the use of common office software, word processing, spreadsheet, and database software are required. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Excellent organizational skills, human relations, and communication skills required.

PREFERRED QUALIFICATIONS

Associate’s degree in Business Management or equivalent preferred.

Certification for CHAA is preferred.

Additional related education and/or experience preferred.

DATE APPROVED 09/18/2022

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

Privacy Policy:

Privacy Policy