Authorization Representative Oral and… at Banner Health · Phoenix

Primary City/State:

Phoenix, Arizona

Department Name:

C/P-OMFS-Clinic

Work Shift:

Day

Job Category:

Administrative Services

The academic medicine difference. At the center of Banner – University Medicine is patient care, research, and teaching. Join a nationally recognized health care leader and experience the future of medicine today.

Banner – University Medical Center Oral and Maxillofacial Surgery Clinic provide the full scope of oral and maxillofacial surgery. We treat Facial trauma, Head and neck pathology/infections, Sleep apnea, and TMJ dysfunction. In addition, we provide corrective jaw surgery for congenital and acquired anomalies, as well as routine surgeries such as wisdom teeth extraction, routine dental extractions and dental implants.

As an Auth Rep supporting this team, you will be using the OMFS program and contacting insurances for authorization purposes. Prefer at least one year of authorization experience, but will accept general insurance authorizations if necessary.

This is a full time (40 hours/week), day shift position: Monday-Friday 8:00AM-4:30PM. Clinic is closed on weekends and holidays.Work with a diverse team, learn about medical and oral surgery at the same time, growth within Banner and/or department.

University Medical Center Phoenix is a nationally recognized academic medical center. The world-class hospital is focused on coordinated clinical care, expanded research activities and nurturing future generations of highly trained medical professionals. Our commitment to nursing excellence has enabled us to achieve Magnet™ recognition by the American Nurses Credentialing Center. The Phoenix campus, long known for excellent patient care, has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona College of Medicine - Phoenix. Additionally, the campus responsibilities include fully integrated multi-specialty and sub-specialty clinics and has operations in multiple locations spanning across the Phoenix metropolitan city.

POSITION SUMMARY
This position is responsible for obtaining and processing all pertinent clinical information needed for the authorization of professional and medical services. The position responds to patient referrals and works insurance companies to pre-certify services based on the patient’s benefit plan.

CORE FUNCTIONS
1. Responds to patient referrals for tests, procedures, and specialty visits. Obtains authorizations required by various payors; including verification of patient demographic information, codes, dates of service, and clinical data. Re-certifies services when necessary.

2. Authorizes and schedules appointments. Answers questions regarding the authorization process and supplies information to physicians, patients, and third party payers. May, depending on department/location, inform patients about necessary preparation for procedure or test.

3. 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 and informs them of eligibility issues. Works with staff and patients regarding denials and appeals.

4. Documents and maintains records of all referral activity and authorizations.

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

6. This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

Must possess effective verbal and written communication skills.

Must be proficient with commonly used office software.

PREFERRED QUALIFICATIONS

One or more years of experience normally gained in a medical office or insurance environment. Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD9 and CPT codes.

Additional related education and/or experience preferred.

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