AUTHORIZATION REPRESENTATIVE

Description

Job Title          

Authorization Representative 

Department

Authorizations

Reports to

Authorization Manager

Status

Full Time/Non-Exempt

Authorization Representative Position Summary

The Authorization Representative is primarily responsible for verifying patient eligibility and securing authorizations before the patient’s scheduled appointment. The Authorization Representative will communicate the status of the authorization request to the referring provider and patient as needed. The Authorization Representative will also serve as a backup to the Denials Representative and, if required, will communicate the outcome of the authorization request and discuss all options available to the patient, including opting to self-pay or signing a waiver as needed. The Authorization Representative will contribute to building a collaborative, team-focused environment by establishing strong working relationships with payors, patients, referring physicians, and internal staff. The Authorization Representative job function is a value-added service requiring commitment to “World Class Customer Service”.

Authorization Representative Detailed Responsibilities

• Use a real-time exam work list to prioritize tasks to ensure prior authorization is completed before the scheduled exam date and time.
• Responsible for verification of patient insurance eligibility. 
• Determine individual insurance plan radiology benefits for scheduled exams.
• Obtain clinical history from the referring physician to obtain authorization for a scheduled exam.
• All eligibility, authorization, and determination of benefits information obtained are to be documented appropriately.
• Upon completion of the eligibility and authorization process, update/change authorization status appropriately.
• Add any waiver tasks in RIS as needed.
• Communicate with patients and referring physicians on non-covered benefits or exam coverage issues as needed.
• Adheres to all HIPAA Guidelines.
• Provide assistance to Imaging Center Staff, Scheduling Staff, and Assessment Coordinator Departments regarding Authorization and Eligibility. 
• Stay informed; communicate any updates and changes in payor authorization requirements.
• Inform the department leadership team of potential problem cases to receive directions on resolving situations and preventing escalations.
• Responsible for assisting with exams for prior dates of service as needed. 
• Participate in team and payor meetings.
• Attend scheduled training courses on new and revised authorization and denial processes. 
• Answers incoming calls in the Authorization queue as needed.
• Performs other related duties as assigned or requested.

Authorization Representative Specific Job Knowledge, Skill, and Ability

• Proficient knowledge of radiology authorization processes and procedures.
• Demonstrated ability to perform authorization job functions.
• Proficient knowledge of medical terminology.
• Proficient understanding of radiology exams.
• Proficient knowledge of insurance plan authorization guidelines and medical coverage guidelines. 
• Proven track record of producing high-quality work.
• Strong written and verbal communication. 
• Displays excellent interpersonal skills with the ability to interact tactfully and diplomatically with patients, families, referring physician’s staff, insurance plan representatives, and internal customers. 
• Demonstrated commitment to “World Class Customer Service”.
• Highly organized and detail-oriented, able to handle multiple tasks within short timelines by prioritizing and organizing work to complete tasks promptly and accurately.
• Demonstrates a pleasant disposition and positive attitude,
• Possesses the ability to maintain a cordial and professional approach during periods of stress.
• Dependable and flexible.
• Fosters and reinforces team-based results.
• Positively anticipates and adapts to change (e.g., policy, operational, procedural, insurance, protocol, scheduling, etc.). 
• Proficient knowledge of all departmental applications and systems. 
• Proficient knowledge and operation of email, instant messaging, internet, and intranet.
• Excellent computer skills.

Requirements

Education and Experience

• High School Diploma or Equivalent is required.
• At least 1 year of medical authorization experience is preferred.

Physical Requirements

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk and hear. The employee is frequently required to sit. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.