Pre-Authorization Representative

Position Summary

Verify all patients tests, stays, and procedures have prior authorization and referral. Will also assist in verifying all patient eligibility and benefits. Work with with physician offices in a service excellence manner in order to best serve our patients and physicians. Complete all necessary forms and use computer applications for majority of their position. Work elective scheduled accounts out five days and add-on accounts to reduce risk of denial.

Minimum Qualification

• High school diploma or GED required
• 3 years medical office experience preferred including authorizations.
• Computer skills: Hospital or clinic EMR, Microsoft Office and Revenue Cycle applications
• Excellent critical thinking, interpersonal verbal and written communication skills

Essential Job Functional

• Meets all active working position requirements in regards to accuracy, timeliness, and completeness of work performed.   Accurately documents patient financial responsibility. .
• Achieves and maintains benefits and authorizations of scheduled accounts completed five days out and inpatient accounts next business day.
• Achieves and maintains 95% accuracy or above in benefit assignment.
• Achieves and maintains 95% accuracy or better in denial rate
• Manages workload and performs in a service excellence manner to best represent the facility and department. Works closely and effectively with all departments and physician offices to facilitate authorization of patient procedures to reduce the risk of denial. Appropriately works add on accounts to reduce risk of denial.
• Will assist Financial Counselor in notification and working with case management as needed
• Knowledgeable of patient rights and position specific advance directives. Considers patients/families language, cultural, and religious beliefs when providing service. Performs well in stress and emergency situations.
• Exhibits willingness to master new skills. Consults supervisor for additional assignments or independently assumes responsibility for unassigned tasks when needed. Accepts and acts upon constructive criticism.
• Verifies Medicare Medical Necessity and provides assistance to physicians offices as needed
• Checks Medicaid tests/procedures for above or below the line guidelines.
• Utilizes computer applications for majority of authorizations and referrals
• Manages recurring appointments authorizations, referrals, and pending authorizations

Knowledge, Skills and Abilities

• Demonstrate sound judgment, patience and maintain a professional demeanor at all times
• Ability to work in a busy and stressful environment
• Organizational skills and the ability to prioritize
• Creativity, problem analysis and decision making
• Excellent computer aptitude.

WVMC is an Affirmative Action, Equal Opportunity Employer. If you have any special need or seek accommodation to aid your participation in our hiring process, please contact us at (503) 472-6131