Authorization Representative

Job ID: J119048
Company: Allegheny Health Network
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

GENERAL OVERVIEW:

Works with Case Management staff to obtain third-party payor authorization for appropriate level of care to enable discharge of patients.

ESSENTIAL RESPONSIBILITIES:

  • Coordinates with Case Management on an ongoing basis to initiate 3rd party authorizations as assigned, at the requested level of care. (30%)
  • Gathers and facilitates accurate transfer of patient-related information to insurer and to case manager through interaction with referral sources, patients and medical record review by phone, fax, or online interface as required. (30%)
  • Coordinates the transfer of essential patient care information with the inpatient authorization unit to facilitate changes to level of care, as appropriate. (20%)
  • Maintains database of insurance payor contacts, including phone numbers, fax numbers, names and the appropriate process to obtain authorizations. (10%)
  • Obtains authorizations for complex medication or DME needs on an as requested basis. (5%)
  • Performs other duties as assigned. (5%)

QUALIFICATIONS:

Minimum

  • High School diploma

Preferred

  • Associate's degree in Healthcare Information Management or Healthcare Administration
  • 1-3 years of experience with care coordination in a healthcare setting
  • 1-3 years of experience with medical terminology
  • 1-3 years of experience of ICD coding and reporting guidelines

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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