PAS Pre Service Prior Authorization Representative

Department Name:

Centralized Pre-Regist-Corp

Work Shift:

Day

Job Category:

Revenue Cycle

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Our remote authorization team is looking for motivated individuals that enjoy working in a fast-paced, high-volume department. This department is a part of the Patient Access team and we have opportunities for further education, career growth, and mentorship. The position also enjoys the benefit of working from home.

The PAS Authorization Representative will obtain and complete insurance authorization requests. They are responsible for verifying and understands insurance benefits, validating authorization requirements. Verifies patients Insurance and accurately inputs this information into our systems, including documenting the account thoroughly in order to maximize reimbursement and minimize denials/penalties from the payor(s) documentation required by the patient’s insurance plan(s). Must be able to consistently meet monthly individual accuracy and productivity goals as determined by management.

Full Time Hours are Monday- Friday 8:30AM-5:00 PM AZ Time

3 years of procedure auth/referral experience or surgery scheduler needed.

Knowledge of Insurance Payers; Knowledge of ICD 10; Problem solving skills also needed. Self-Starter who can work independently. Patient oriented with great communication skills and Is eager to be the solution in any circumstance. Computer experience and working out of multiple systems needed.

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

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.

MINIMUM QUALIFICATIONS

High school diploma/GED is required.

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

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 in CRCR and/or CHAA preferred.

Additional related education and/or experience preferred.

Estimated Pay Range:

$20.01 - $30.01 / hour

Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.

This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

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