Pre-Authorization Representative I

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This job is responsible for ensuring that payers are prepared to reimburse AHN for scheduled services in accordance with the payer-provider contract.  The representative contacts payers to request service authorization and may collect financial and or demographic information from patients and refers accounts to financial advocates if authorization is not obtained as needed.

ESSENTIAL RESPONSIBILITIES

• Obtains prior authorizations from third-party payers in accordance with payer requirements.  Remains current on all regulations, policies and procedures and process changes that are essential to completing assigned daily tasks. (50%)
• Verifies patient's Insurance and benefits information.  Performs any written and/or verbal communication necessary to exchange information with designated contacts.  (15%)
• Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality. (10%)
• Works with other departments to gather the clinical information required by the payer to authorize services. (5%)
• Works with business office to support appeal efforts for authorization-related denials. (5%)
• Maintains accurate records of authorizations within the EMR. (5%)
• Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR. (5%)
• Identifies patients who will need to receive Medicare Advance Beneficiary Notices of noncoverage (ABNs). (5%)
• Performs other registration duties as requested   

QUALIFICATIONS:

Minimum

• Associate's Degree Healthcare or Business Administration OR 3 years of related experience in a Healthcare setting
• 1 year with medical terminology and healthcare insurance processes
• Excellent communication and customer service skills
• Proficiency in the use of healthcare information systems
• Ability to prioritize and multitask
• Maintains professional tone at all times when communicating with patients and payer representatives
• Critical problem solving skills
• Experience within financial clearance setting
• Strong attention to detail

Preferred

• Patient Access certification
• Revenue Cycle Specialist certification

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$19.25

Pay Range Maximum:

$29.07

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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