Prior Authorization Representative

at  Ascension

REQUIREMENTS

Education:

• High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
• Note: Required professional licensure/certification can be used in lieu of education or experience, if applicable.

Determine and verify insurance coverage and coordination of benefits from all sources for assigned area. Ensure proper adequate and timely billing to ensure prompt payment.

• Confirm insurance coverage. Determine necessity for pre-authorization and obtain authorization for scheduled procedures.
• Determine financial responsibility for services to be provided. Notify patients and/or practitioners of any services requested and/or referred that are not authorized by insurance.
• Communicate with patients and practitioners regarding financial responsibility and insurance coverage issues.
• Maintain detailed documentation in the patient account record of all billing activities. Maintain documentation of claims processed as part of the daily claims reconciliation process.
• Prepare and complete claims for commercial insurance companies, third party organizations and/or government or self payers.
• Research, analyze and reconcile Medicare/Medicaid billing and reimbursement practices.
• Maintain detailed documentation in the patient account record of all billing activities. Maintain documentation of claims processed as part of the daily claims reconciliation process.
• Consult with appropriate parties to resolve unbilled claims. Review recent accounts for proper billing practices and reimbursement.