Prior Authorization Representative

Location: Carbondale, IL

Shift: Day

Time Type: Full Time

Facility/Clinic Name: System Office

Position Summary

Responsible for patient prior authorization, patient referrals including

scheduling of internal referral and outgoing patient referrals,

documentation of status of prior authorizations and referrals, ability to

navigate registration, referral entries, auth/cert entries and patient chart

workflows in EPIC, ability to update and confirm current patient insurance

coverage and day to day monitoring of all EPIC prior authorizations and

referrals work queues.

Principal Accountabilities

Standards of Performance: Respect, Integrity, Compassion,

Collaboration, Stewardship, Accountability, Quality

Education

• High School diploma or equivalent

Licenses and Certification

• N/A

Experience and Skills

• Technical Experience: 1 to 3 years of office experience required and 1 year EMR experience preferred.

• Effective and excellent communication skills

Role Specific Responsibilities

• Monitors EPIC prior authorization and referrals work queues daily

• Classified insurance approvals, based on physician orders, in order to expedite claim processing.

• Identify and prioritize urgent and emergency prior authorizations and referral consultation requests

• Checks chart for relevant referral/prior authorization information and shares with appropriate insurance provider or referring office provider

• Call or submit online request to insurance providers for prior authorizations

• Communicates details regarding denials and peer-to-peer request for prior authorizations and provider offices

• Communicates effectively with patients, provider staff and insurance providers by telephone and Epic Inbasket

• Follow through on referrals and prior authorizations to completion/resolution in a timely fashion

• Document progress/status of prior autho.rizations and referrals on the EPIC referral or EPIC auth/cert forms

• Follow-up on missing insurance documentation with patients

• Schedules internal referrals in EPIC directly onto the provider’s schedule.

• Validates information for a prior authorization or referral request and follows-up with providers office regarding missing CPT codes or missing chart documentation

• Collaborates with staff to identify workflow problems and identify solutions

• Consistently looks for ways to streamline the prior authorization and referrals process an improve the patient and staff experience

• Leads, tracks, monitors updates in insurance prior authorization criteria and educate provider staff