About the position The Precertification and Authorization Representative is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations.

Requirements

• High School Diploma or GED and 2+ years of relevant experience required OR Bachelor’s degree required
• Ability to read and communicate effectively
• Basic computer/keyboarding skills, intermediate mathematic competency
• Good written and verbal communication skills
• Knowledge of proper phone etiquette and phone handling skills
• Position requires general knowledge of healthcare terminology and CPT-ICD10 codes.
• Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view.
• Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.

Nice-to-haves

• Prior Auth / Authorization experience
• Cancer Services experience
• Microsoft Office experience
• Radiation Oncology experience
• Insurance Verification experience
• Appeals experience
• Pre Determination experience
• Basic knowledge of and experience in insurance verification and claim adjudication is preferred.
• Knowledge of Denial codes is preferred.
• Knowledge of and experience using an Epic RC/EMR system is preferred.
• Healthcare Financial Management Association (HFMA) Certification Preferred.