Patient Access Services Authorization Representative
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Job Description
Remote authorization representative securing payer approvals for Banner Health, a nationally recognized healthcare provider. Verifying insurance, codes, referrals, and clinical data to prevent denials.
Responsibilities:
- Perform insurance verification and authorization functions supporting Patient Access Services
- Accurately complete authorization initiation requests with payers for all service lines
- Validate existing authorizations requested by providers
- Complete authorizations for acute and ambulatory visits using standard submission tools and websites
- Document authorization updates and referral activity in Host systems
- Provide authorization numbers and patient demographic information to billing and other appropriate staff
- Explain referral processes to physicians and staff
- Refer encounters for peer review to substantiate ordered procedures
- Respond to provider orders for tests, procedures, and specialty visits
- Obtain authorizations for single and recurring visits, verifying demographics, codes, dates of service, and clinical data
- Stay current on payer requirements and use third-party authorization submission software
- Work independently from a remote location and follow structured work routines
- Prioritize work and ensure appropriateness and timeliness of patient care
- Escalate accounts not meeting authorization standards to providers, scheduling departments, PAS leaders, and administrative groups
- Perform other related duties, including cross-coverage in authorization-related areas
Requirements:
- High school diploma/GED required
- Minimum of three years of experience in healthcare insurance and/or authorizations
- Minimum of two or more years of healthcare insurance authorizations in Imaging, Surgery, Pharmacy, or other procedures
- Minimum of one year of health insurance experience
- Basic knowledge of CPT and ICD Codes
- Reliable internet with Ethernet connection only; Wi-Fi is not permitted
- Quiet work area/home office
- Great customer service and problem-solving skills
- Business skills and experience in the assigned work area
- Detail oriented
- Ability to maintain high productivity standards with minimal errors
- Advanced abilities in common office software, word processing, spreadsheet, and database software
- Ability to manage multiple tasks simultaneously with minimal supervision
- Ability to work independently
- Excellent organizational, human relations, and communication skills
- Certification in CRCR and/or CHAA preferred
- Associate’s degree in Business Management or equivalent preferred
Benefits:
- Great Place To Work® certified employer
- Remote work arrangement
- Monday–Friday day schedule
- Opportunity to support a nationally-recognized healthcare leader
- Stimulating and rewarding careers
- Drug-free work environment
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