Primary City/State:

Mesa, Arizona

Department Name:

Patient Accounting-Hosp

Work Shift:

Day

Job Category:

Revenue Cycle

Schedule: Monday - Friday 8:30am to 5:00pm MST

Requires minimum of three years of experience in healthcare insurance and/or authorizations.

Good health care is key to a good life. At Banner Health, we understand that, and that’s why we work hard every day to make a difference in people’s lives. Do you like the idea of making a positive change in people’s lives – and your own? If so, this could be the perfect opportunity for you.

The Banner Authorization team is looking for motivated individuals that enjoy working in a fast-paced, high volume department. This department is a part of the Patient Access team and we have opportunities for further education, career growth, and mentorship. The position also enjoys the benefit of working from home.

This PAS Authorization Representative will obtain and complete insurance authorization requests for exams scheduled at Banner Imaging. They will work from a worklist of scheduled exams, verify insurance eligibility/benefits, and request authorization for the exam. Sometimes additional documentation or information is needed and you will provide that to get approval for the exam.

Located in Susanville in northeast California, Banner Lassen Medical Center offers comprehensive care in a state-of-the-art facility to aid in the prevention, diagnosis, and treatment of illnesses. Our 25-bed medical center has a proud history of providing vital caring to the community since 1883. Though we are a small community hospital, we have invested in the latest medical equipment, including a 16-slice CT scanner, nuclear medicine, MRI, ultrasound, bone density, mammography and CAD. The hospital also offers infusion and oncology therapy, respiratory therapy and cardiopulmonary services as well as laboratory services, inpatient and outpatient surgery and a 24-hour emergency department. Away from work, you'll find that our location at the foot of the scenic Sierra Nevada Mountains offers an unlimited variety of recreational activities, including fishing, camping, golfing, hiking and skiing.

POSITION SUMMARY

This position performs insurance verification and authorization functions that support Patient Access Services and ensures compliance with both department standards and billing requirements. This position requires the ability to retain large amounts of changing payor information/knowledge crucial to attaining reimbursement for the services provided. This position is expected to reduce authorization-related initial denials/write-offs.

CORE FUNCTIONS

1. Uses department procedures and new hire training to accurately complete authorization initiation requests with payers for all service lines and validates existing authorizations requested by providers. Completes authorization initiation for acute and ambulatory visits. Utilizes standard authorization submission tools, websites, and documents authorization updates in Host systems.

2. Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing. Provides information about the referral process to physician and staff. Documents and maintains records of all referral activity and authorizations in appropriate Host fields. Refers encounters for peer review to substantiate ordered procedures.

3. Responds to “provider orders” for tests, procedures, and specialty visits. Obtains authorizations for single and/or reoccurring visits required by various payers, including verification of patient demographic information, codes, dates of service, and clinical data. Representatives will stay current on payor requirements and utilization of third-party authorization submission software to complete authorizations.

4. Works independently from a remote location and follows structured work routines. Works in a fast-paced environment requiring independent decision making and sound judgment to prioritize work and ensure appropriateness and timeliness of each patient’s care.

5. Follows escalation protocols for accounts not meeting authorization standards by working with the ordering provider, scheduling departments, PAS leaders, and administrative groups for resolution in all acute, ambulatory, Banner Imaging, and Oncology service lines.

6. Performs other related duties as assigned. This may include cross-coverage in other authorization-related areas.

MINIMUM QUALIFICATIONS

High school diploma/GED is required.

Requires minimum of three years of experience in healthcare insurance and/or authorizations.

Certification for CRCR required within one year of hire.

Business skills and experience in the assigned work area are required. Must be detail oriented. Must be able to maintain high productivity standard with minimal errors. Advanced abilities in the use of common office software, word processing, spreadsheet, and database software are required. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Excellent organizational skills, human relations, and communication skills required.

PREFERRED QUALIFICATIONS

Associate’s degree in Business Management or equivalent preferred.

Certification for CHAA is preferred.

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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