Position Summary:
The Pre-Authorization Representative will ensure they gather all information needed to
attempt to complete approval of any Radiology and/or Procedures. This requires the PA Rep
to process the entire Pre-Authorization process to include all current insurances, PA
requirements, gathering all information from the chart and scheduling Peer to Peer reviews
when required. The PA Rep will continually follow up with insurance companies, Medical
offices, Central Scheduling, Provider and the patient to keep all updated through the process
until completed.
Primary Position Responsibilities:
1. Responsible for ensuring that insurance requirements and financial obligations are obtained
and communicated to patients as appropriate for collection of elective hospital services prior
to date service and/or billing.
2. Maintain knowledge in pre-certification processes and policies. Keeps up to date with
insurance changes/requirements pertaining to Prior Authorizations.
3. Secures pre-certification as quickly as possible, in the appropriate timeframe per insurance.
4. Obtains medical necessity verification. Updates Prior Authorization information in all relevant
systems.
5. Collaborates closely with Central Scheduling team to ensure the patient is scheduled as
quickly as is appropriate.
6. Communicates pre-authorization status and financial responsibility as appropriate to patients
for scheduled procedures.
7. Assists with other clerical duties as needed.
Qualifications:
Minimum Education:
Required: High School Diploma or Equivalent
Preferred: None
Minimum Years of Experience:
Required: One year of medical office/hospital registration/patient accounting experience
Preferred: Knowledgeable in pre-certification processes and policies
License, Registry or Certification:
Required: None
Preferred: None
Knowledge, Skills and/or Abilities:
Required: PC Skills, Excellent Customer service skills, Detailed oriented, Multi-tasking skills
Preferred: Medical terminology, Insurance knowledge