Authorization Representative Job Description
Authorization representative
provides administration of medical management programs that include: prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development and medical claims audits.
Authorization Representative Duties & Responsibilities
To write an effective authorization representative job description, begin by listing detailed duties, responsibilities and expectations. We have included authorization representative job description templates that you can modify and use.
Sample responsibilities for this position include:
Knowledge of payer requirements for authorization and billing
May be required to flag accounts for high dollar financial clearance
Validates Veteran and medical provider demographic information including correct selection of a medical provider by specialty for healthcare service
Determines whether Veterans are eligible to receive health care benefits under the program by determining the patients’ status/eligibility, and the appropriate authorization path
Contacts medical provider offices by telephone, schedules and cancels patient appointments, and notifies Veterans for all requests
Follows step-by-step instructions, including redirecting Veterans to appropriate providers for care, as required by contractual standards
Coordinates with providers new to the program to collect demographic information and establish an agreeable reimbursement rate
Identifies, analyzes and resolves a variety of scheduling issues
Formulates brief sentences/paragraphs from authorization orders and requests correspondence to providers/Veterans including clinical information when available and validates provider/Veteran demographics for accurate delivery of correspondence
Documents transactions in authorization system and communicates via written correspondence to the Veteran’s Administration when needed
Authorization Representative Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Authorization Representative
List any licenses or certifications required by the position: NIST, RMF, MA
Education for Authorization Representative
Typically a job would require a certain level of education.
Employers hiring for the authorization representative job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in Technical, Medical, Education, Accounting, Management, Medical Terminology, Supervision, Sciences, Graduate School, Faculty
Skills for Authorization Representative
Desired skills for authorization representative include:
Microsoft Office and Windows based programs
Health insurance industry and claims processing
Utilizing online eligibility pre-certification tools made available
Medical terminology
ICD-10 and CPT coding
Microsoft Office
Coding and billing
Medical office operations
Medical terminology and third party insurance processes
Payer requirements for authorization and billing
Desired experience for authorization representative includes:
Accounts accurately for personal production via a production report that includes outcome data such as closed transactions, duplicative transactions and requests
Meets goals and produces results through tracking performance, improving work processes, and prioritizing work and tasks
Achieves successful solutions by reviewing situations and ensuring a full understanding before taking steps to resolve
Additional duties as required that support department needs
Oral communication skills including the ability speak, clearly read, comprehend and interpret a script for outbound telephone calls providing information and instruction to medical providers and patients
Knowledge of and skill in using appropriate office etiquette and professional composure, and proficiency to answer questions providing basic, factual information
Authorization Representative Examples
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Authorization Representative Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of authorization representative. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for authorization representative
- Track correspondence through the process to ensure a timely response within service level agreements
- Facilitate and document communication with insurers, and employer groups
- Effectively and clearly document communication across multiple systems
- Answer incoming queries via the telephone, email, and hard copy
- Maintain confidentiality of all PHI (Oral, written or maintained electronically) ,and adhere to HIPAA guidelines
- Obtains and/or works with Hospital Departments to obtain authorizations in a timely manner
- Reviews the insurance verification and completes the authorization process within established time frames
- Receives coverage authorization and works diligently to meet established timelines
- Works closely with and supports team efforts to accomplish authorization/verification
- Requests authorization from insurance company/Hospital Department to provide specific services and parameters of care
Qualifications for authorization representative
- Ability to identify problems and apply good judgment
- Minimum two years of experience in claims billing, authorizations, admissions for hospital/provider and coordination of benefits
- Proven ability to apply and communicate analytical and critical thinking to complex processes
- Intermediate computer skills, must possess ability to navigate multiple systems
- Basic Word and intermediate Excel and Outlook skills
- Must speak, read, and write in fluent English
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Authorization Representative Job Description
Job Description Example
Our innovative and growing company is hiring for an authorization representative. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for authorization representative
- Previous insurance verification experience
- Previous customer service work experience
- 3 years of Insurance Verification Experience, and at least 1 years of Authorizations experience
- 5 years of insurance verification and at least 2 years of Authorization experience (Preferred)
- Inbound call center environment from service providers and current internal and external customers nationwide
- Work closely with referral providers, insurance companies patient accounts and support staff
- Actively participate in practice’s utilization management, customer service and information management activities
- Explain various referral policies
- Use active and skilled communication skills
- Requests, inputs, verifies, and modifies patient’s demographic, primary care provider, and payor information
Qualifications for authorization representative
- Proficient computer skills in Excel, Word, Lotus Notes (email system), efficient research skills and proficient skills in navigating various computer software applications
- WC and NF insurance experience
- We will accept work at home associates
- Expert communication and customer service skills
- Associate’s Degree in business or accounting required
- Minimum 1 year of experience in the field or in a related area
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Authorization Representative Job Description
Job Description Example
Our growing company is hiring for an authorization representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for authorization representative
- Requests Prior authorization from carriers through web portals for testing
- Requests Benefit Investigation documentation from insurance carriers
- Verifies insurance eligibility with various government and commercial insurance carriers
- Follows up on Prior Authorization approvals and denials
- Pulls EP assignments
- Communicates effectively with insurance carriers
- Ensures that patient demographics, insurance information, verification and eligibility have been established and documented
- Maintains excel spreadsheet with patient demographics and tests data
- Provides weekly and monthly reports on productivity to the management
- Provides backup for front end revenue cycle processes as needed
Qualifications for authorization representative
- Experience in a physician group practice
- Minimum of one year of experience in Patient Financial services department or related area such as registration, finance, collections, customer service, medical office, or contract management
- Minimum 1-year experience in Patient Financial Services Department or related area (registration, finance, collections, customer service, medical office, contract management)
- Analytical skills with the ability to identify, research and resolve issues or recommend solutions
- One year general office experience which includes public interaction required
- Medical insurance experience preferred
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Authorization Representative Job Description
Job Description Example
Our growing company is looking for an authorization representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for authorization representative
- Take reports from technicians about repairs needed
- Authorize repairs
- Schedule technicians for follow up items
- Explain policies to policy holders
- Performs pre-service authorization reviews to obtain payment authorization for both inpatient and outpatient services
- Performs the following activities to support the effective operation of the organization’s quality management system
- Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients
- Collaborate with and engage internal and external customers, such as facility patient access and physician offices, in opportunities for prevention of future disputes
- Verifies pre-certifications and obtains upgrades if needed
- May be required to greet patients in person and notify clinical staff of arrival
Qualifications for authorization representative
- Medical prior authorizations or claims experience in a managed care setting highly preferred
- Three to five years’ experience in a customer service setting
- Requires minimum one year experience in a production/data entry environment performing alpha and numeric data entry in a healthcare related organization such as managed care, claims/billing, health insurance, customer service, call center, or claims office
- Ability to read, comprehend and retain written and oral instructions
- Experience in healthcare setting desirable
- No licensure or certification requirements
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Authorization Representative Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of authorization representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for authorization representative
- Initiates and prepares written correspondence as needed and based on functional needs
- Processes and reviews all patient data for accurate and complete insurance information
- Uses multiple platforms to complete and submit all necessary insurance forms for prior-authorization requests for state Medicaid and numerous commercial insurance carriers
- Obtains medical records and lab reports when necessary
- Contacts client accounts with pertinent patient testing updates
- Effectively communicates with insurance carriers as needed to obtain prior authorization protocol
- Maintains process of prior authorization requests follow up
- Request initial authorization from insurance companies from both government and commercial payors
- Assist error processing team in assigning correct payors on new accounts in the billing system
- Send authorization documents to scan
Qualifications for authorization representative
- CRCR (Credentialed Revenue Cycle Representative) preferred
- Knowledge of payor programs
- Excellent interpersonal skills and positive work ethic and leadership skills
- Verbal ability is required in discussing confidential admitting and financial matters with patients and/or guarantors
- Experience and understanding of the hospital and/or medical environment
- Medical and insurance terminology is essential