Authorizations Representative

Job Description

This position is responsible for obtaining insurance eligibility and benefits information, securing required authorizations, reviewing all insurance eligibility responses, and communicating with physicians’ offices and insurance companies to correct or confirm information. The role collaborates with Utilization Review staff to ensure authorizations cover needed services and may estimate service cost and patient responsibility. The candidate refers patients with questionable coverage to Eligibility Counselors and may assist in mentoring new hires.

Schedule

4‑day work week with alternating days off.

Responsibilities

Obtains insurance eligibility and benefit information using various phone and online resources.

Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed.

Works with Utilization Review staff and / or physicians’ offices to assure eligibility and authorization requirements are completed within the required timeframe.

Communicates with nursing and / or billing staff when changes affect reimbursement.

Makes appropriate corrections in the patient’s record to prevent denials and billing problems.

Immediately refers ‘at risk’ admissions to eligibility (e.g., out of network, underinsured, max benefits).

Works with insurance eligibility responses and other reports; resolves issues with physicians and patients to prevent billing delays.

Maintains a satisfactory level of performance and adherence to workload standards.

Estimates cost of service using ICD‑9 or CPT codes.

Interprets 271 response, including insurance terminology, in an online tool to determine patient responsibility.

Performs calculations using insurance benefit information to accurately estimate patient responsibility.

May lead or train new employees in account preparation and review functions.

Minimum Qualifications

Two years of customer service experience.

Demonstrated good communication and computer skills.

Preferred Qualifications

Demonstrated knowledge of medical terminology.

Experience in admitting, billing, collections, and / or insurance verification.

Bi‑Lingual Spanish speaking.

Demonstrated knowledge of CPT / ICD‑9 codes.

Physical Requirements

Interact with others requiring the employee to communicate information.

Operate computers and other office equipment requiring the ability to move fingers and hands.

See and read computer monitors and documents.

Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location

Intermountain Health St. George Regional Hospital, St. George, Utah

Work State

Utah

Scheduled Weekly Hours

40

Salary Range

$18.39 – $24.99 per hour

Equal Opportunity Statement

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Notice of Position Closure

All positions subject to close without notice.

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