Patient Access Services Authorization Representative

Job Description:

• Perform insurance verification and authorization functions supporting Patient Access Services
• Complete authorization initiation requests with payers for acute and ambulatory visits
• Validate existing provider-requested authorizations
• Use authorization submission tools, payer websites, documents, and Host systems
• Provide authorization numbers and patient demographic information to billing and other appropriate staff
• Explain referral processes to physicians and staff
• Document and maintain referral and authorization records
• 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, service dates, and clinical data
• Stay current on payer requirements and use third-party authorization submission software
• Work independently from a remote location using structured work routines
• Prioritize work and ensure appropriateness and timeliness of patient care
• Escalate accounts that do not meet authorization standards and coordinate resolution with providers, scheduling departments, PAS leaders, and administrative groups
• Perform related duties, including cross-coverage in other authorization-related areas

Requirements:

• High school diploma/GED required
• Minimum of three years of experience in healthcare insurance and/or authorizations
• Minimum of two years of healthcare insurance authorizations experience in imaging, surgery, pharmacy, or other procedures
• At least one year of health insurance experience
• Great customer service and problem-solving skills
• Basic knowledge of CPT and ICD codes
• Reliable internet with Ethernet connection only; no Wi-Fi
• Quiet work area/home office
• Ability to work Monday–Friday, 8:00 a.m.–5:30 p.m. Mountain Standard Time or Arizona Time
• Business skills and experience in the assigned work area
• Detail-oriented with ability to maintain high productivity and minimal errors
• Advanced abilities with common office, word processing, spreadsheet, and database software
• Ability to manage multiple tasks simultaneously with minimal supervision and work independently
• Excellent organizational, human relations, and communication skills
• Associate’s degree in Business Management or equivalent preferred
• CRCR and/or CHAA certification preferred

Benefits:

• Great Place To Work® certified employer
• Banner Health total rewards package (specific components not listed)