PRIOR AUTHORIZATION REP at Southwest General – Middleburg Heights, Ohio

Position summary: The Prior Auth Rep position reviews patients accounts to determine if an authorization is needed for their services. If authorization is required they work with insurance companies and physician offices to obtain authorization for outpatient services throughout the Health Center. This position in a fast paced office environment. The Prior Auth Rep also pre registers, verifies insurance coverage and provides third party benefit education to customers. This position mentors new teammates and helps with auditing new hire workload.

Education: High School diploma or GED required Bachelor's degree accepted in lieu of 1 year experience

Required length and type of experience: 2 years' experience in patient registration, scheduling or related medical field using computers Medical Terminology

Required licensure, certification or registry: CHAA or related medical certification

Below are the duties and responsibilities for this position.

• Pre register patients verifying the patient's record and meets the goal for the quality of their registration to include the patient registration, demographics, insurance coverage for eligibility, medical necessity checks (when applicable), and any other registration function.
• Updating and re-verifying insurance as necessary. Successfully works with payers via electronic/telephonic, email and/or fax communications.
• ​​​​​​​Responsible for verification and investigation of pre-certification, and authorization.
• ​​​​​​​Coordinates and supplies information to the payer, including medical information and/or a letter of medical necessity for determination of benefits.
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
• Responsible for updating and maintaining insurance and authorization information within Cerner.
• Maintaining updated copies of paper authorizations and authorization packets scanned into Cerner.
• ​​​​​​​Safeguards the organization that prior authorization has been obtained prior to patient's date of service.