Prior Authorization Representative

Job Description

Networks Connect is looking for a Prior Authorization Representative that will work in office. Networks Connect is conducting a search on behalf of our client, a local prominent health system. Are you skilled in navigating insurance prior authorization processes and looking for an opportunity to make a difference in patient access? Join our Client’s team as a Prior Authorization Representative (PRN | As Needed) and help facilitate seamless access to care while improving financial outcomes for scheduled services. Collaborate directly with referring physician offices, payors, and patients to ensure full clearance before care is provided.

Key Responsibilities:

Pre-Service Authorization

• Address payor coordination of benefits (COB) issues to ensure proper claims payment.
• Obtain necessary authorizations for scheduled services and add-on cases, ensuring timely claims submission.
• Verify insurance eligibility and benefits using tools like real-time eligibility systems, payor websites, and phone calls.
• Pre-register patients for upcoming appointments, collect financial responsibility information, and ensure all documentation meets departmental standards.
• Collaborate with Payor Nurse Navigators to reduce delays in patient access and ensure comprehensive documentation for smoother approvals.

Patient Navigation and Financial Notification

• Act as a liaison to resolve custodial or legal issues prior to the patient’s arrival.
• Review insurance benefits, including co-insurance and deductibles, and communicate in-network versus out-of-network benefits.
• Estimate patient financial responsibilities and initiate point-of-service (POS) collections when applicable.
• Advocate for patients by identifying payment assistance options and coordinating with the Financial Information Center.

Organizational Accountabilities

• Uphold the organization’s core principles by delivering exceptional customer service and maintaining confidentiality.
• Demonstrate collaboration and teamwork by partnering with colleagues to achieve departmental goals.
• Identify and implement solutions to improve clinical and administrative workflows, contributing to a positive work environment.

Qualifications:

Education

• High School Diploma or GED (Required).

Experience

• At least 2 years of experience in healthcare payor navigation, claims and billing, registration, and authorization processes (Required).
• Comprehensive knowledge of medical and insurance terminology, including managed care plans (Required).

Skills and Knowledge

• Strong communication skills to interact professionally with patients, physicians’ offices, and insurance carriers.
• Superior customer service and problem-solving abilities.
• Knowledge of insurance guidelines for government and private carriers.
• Familiarity with electronic medical records (EMRs) and software like Cerner or Experian (Preferred).
• Attention to detail and multitasking in complex situations.
• Bilingual abilities (Preferred).
• Successful completion of all Patient Access training assessments.

Why Join Us?

This is a great opportunity for individuals passionate about healthcare administration and patient advocacy. As a Prior Authorization Associate, you will play a crucial role in ensuring patients receive timely care while reducing financial and administrative barriers.

Job Type: Part-time

Pay: $20.00 – $24.00 per hour

Expected hours: 8 – 40 per week

Work Location: In person

Earnings

$20-$24 hourly

Category

Revenue Cycle