Insurance Authorization Representative Senior

At UK St. Claire, our staff is our greatest asset in the mission to create a healthier and more prosperous population. We strive to foster the talent and potential of our employees and prioritize safe working conditions and equal compensation rates to ensure that continual growth is possible. UKSC is a nurturing workplace for all healthcare professionals. We invite you to explore our current job openings and see if our opportunities could be the right fit for you.

Job Description:

Responsible for obtaining pre-authorizations from payer sources. Verifies patient insurance coverage and eligibility. Coordinates with providers and payers to ensure accurate information. Ensures timely completion of verification processes. Supports patient access and billing accuracy.

• Tracks, obtains, and extends authorizations from insurance carriers.

• Records and documents insurance information throughout the pre-certification and prior authorization process.

• Maintains and utilizes electronic medical records and relevant databases independently.

• Obtains, interprets, and submits clinical documentation required for prior authorization reviews.

• Communicates authorization status and delays professionally to physicians and clinical staff.

• Follows up on denied authorization requests and facilitates appeals or peer-to-peer reviews.

• Supports claim submission and denial appeal efforts by clarifying authorization details.

• Resolves claim denials related to the prior authorization process through account and claim review.

• Verifies primary insurance payer for new admissions.

• Contacts insurance payers to obtain visit authorizations.

• Performs audits of referral and payer source information.

• Consults with Intake RN and leadership to gather necessary information for payers.

• Provides required information to insurance and payer sources.

• Assist team members with questions on claim denials.

• Performs other duties as assigned.

High school diploma or equivalent experience

Bachelor’s degree in a related field is preferred

3-5 years of experience in a healthcare, clinical setting, or a relevant area

An equivalent combination of education and experience may be considered.

All experience must be paid and in the same related field.

Part-time and PRN experience will be prorated based on hours worked per week.

Volunteer work and internships for academic credit are not counted.

N/A

A. Lifting, pushing, and/or pulling objects up to 50lbs: 2. Occasional (< 10% of the time)

B. Lifting, pushing, and/or pulling objects over 50lbs: 1. Never

C. Standing or walking with objects up to 10lbs: 3. Intermittent (10% - 50% of the time)

D. Standing or walking with objects up to 25lbs: 2. Occasional (< 10% of the time)

E. Sitting at computer workstation for extended periods: 4. Regular (> 50% of the time)

F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials: 1. Never

G. Repetitive motion: 4. Regular (> 50% of the time)

H. Working at heights above 4 feet: 1. Never

I. Working in confined spaces: 1. Never

J. Risk of injuries from use of equipment on the job: 1. Never

K. Job-related travel: 2. Occasional (< 10% of the time)

L. Loud noises: 1. Never

M. Temperature extremes: 1. Never

N. Hazardous chemicals and fumes including waste: 1. Never

O. Radiation: 1. Never

P. Burns: 1. Never

Q. Cuts/Punctures: 1. Never

R. Bloodborne/airborne pathogens: 1. Never

S. Recombinant DNA or viral vectors: 1. Never

T. Combative/violent people: 1. Never

U. Animal handling (including carcasses): 1. Never

V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A

This position requires regular sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing); intermittent standing or walking with objects weighing up to 10 pounds; occasional standing or walking with objects up to 25 pounds; and occasional lifting, pushing, and/or pulling objects weighing up to 50 pounds.

N/A

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