Role Description
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.
• Processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts.
• Working assigned registration denials for government and non-government accounts.
• Adherence to quality assurance guidelines.
• Meeting established productivity standards to support the work unit’s performance expectations.
Qualifications
• Intermediate level experience in precertification and authorization processes.
• Knowledge of insurance specific plan requirements.
• Experience in hospital, ED, and clinic/ambulatory environments.
Requirements
• Ability to process pre-certification and prior authorization efficiently.
• Familiarity with workers compensation/third party liability (WC/TPL), managed care, and HMO accounts.
• Strong attention to detail and adherence to quality assurance guidelines.
Benefits
• Medical: Multiple plan options.
• Dental: Delta Dental or reimbursement account for flexible coverage.
• Vision: Affordable plan with national network.
• Pre-Tax Savings: HSA and FSAs for eligible expenses.
• Retirement: Competitive retirement package to secure your future.