Full job description

JOB SUMMARY:

The Pre-authorization Administrator is a member of the Patient Financial Services Department. This position is responsible for reviewing and validating insurance eligibility, and coordination of prior authorization pre-certifications, authorization, coordination of benefits, and ongoing communications with insurance companies.

KEY ROLE ACCOUNTABILITIES:

• Verifies accurate patient demographics & healthplan, confirms eligibility verification and member benefit coverage.
• Contacts health insurance Company to determine appropriate prior authorization process. Works closely with clinical teams to obtain and clarify documentation to demonstrate medical necessity when deemed necessary.
• Maintains a high level of understanding of health insurance companies, provider guidelines, and payer updates.
• Responsible for insurance verifications and accurate communications to various stakeholders regarding the insurance coverage.
• Follows up on and assists in rejections from health insurance companies and take any necessary follow up action.
• Serves as a liaison between health insurance companies, staff and patients to resolve any concerns and maintain a positive working relationship.
• Performs urgent requests in a timely manner and escalates issues to Line Manager as deemed necessary.
• Updates the system with any actions, comments or issues that is related to pre-authorization (conversations approvals, partial approval, denials or request of additional information, etc.)
• Maintains proper logs and documentation on assigned requests.
• Covers on-call shifts as per set monthly schedule and compliant with hospital policies and procedures.
• Participates in department meetings and departmental process improvement activities.
• Maintains confidentiality of all patients and medical/clinical information.
• Maintains working documents in accordance with internal record keeping standards.
• Maintains confidentiality at all times.
• Maintains a professional demeanor and upholds the organizational values at all times.
• Follows all Hospital related policies and procedures.
• Participates in professional development activities when applicable.
• Performs other related duties as assigned.
• Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
• Adheres to and promotes Sidra’s Values

QUALIFICATIONS, EXPERIENCE AND SKILLS:

ESSENTIAL

PREFERRED

Education

Bachelor’s Degree in Business, Commerce or other related field

Formal revenue cycle, health insurance and/or patient billing training

Experience

2+ years’ experience in a related role in a healthcare facility or health insurance company

Experience in a large healthcare facility

Certification and Licensure

Professional Membership

Job Specific Skills and Abilities

• Demonstrated organizational and time management skills
• Demonstrated knowledge of medical insurance and coverage
• Demonstrated ability to understand medical terminology
• Demonstrated ability to be flexible and responsiveness to changing workloads
• Demonstrated skill in Customer Service and effective and tactful communications during stressful situations
• Excellent interpersonal and communications skills
• Proficiency with Microsoft Office suite

Fluency in other languages