Prior Authorization Representative, Atrium Health Wake Forest Baptist

Department:

38768 Wake Forest Baptist Medical Center - Otolaryngology Clinics: Medical Plz Miller

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

monday thru friday 7:30am to 4:30 pm

Pay Range

$21.45 - $32.20

EDUCATION/EXPERIENCE:

High school diploma or GED equivalent. Associate's degree in health-related field preferred. Two years office or experience with third party payers and authorization process preferred.

ESSENTIAL FUNCTIONS:

1. Supports the Prior Authorization Utilization Management process by submitting clinical information to third party payers via fax or by Providerlink, and forwarding information regarding approvals or possible denial of scheduled admission to appropriate Prior Authorization Utilization Management staff.

2. Assists Prior Authorization Utilization Managers by relaying necessary information via telephone, fax and/or Providerlink to third party payers.

3. Proactively follows up with third party payers to determine information needs, and provides required information in a timely manner.

4. Receives and documents authorizations in the EMR from insurance companies.

5. Assists with audits specific to the Prior Authorization Utilization Management process.

6. Participates in the Prior Authorization Utilization Management Team Meetings by providing administrative support as well as sharing concerns and ideas for opportunities for process improvement in the follow up process of obtaining prior authorizations.

7. Serves as the primary contact for onsite commercial payer representatives, providing patient information as needed and notating the EMR as well as utilizing Inbasket Escalation pools as necessary to communicate with clinical services awaiting authorization determination.

8. Performs a variety of general office activities to support the UM function.

9. Contacts Third Party payers to change date of services for authorization requests that have already been submitted and/or determination made and documenting in EMR.

10. Performs other duties as assigned.

SKILLS/QUALIFICATIONS:

• Ability to display and maintain good interpersonal skills
• Ability to organize work projects
• Ability to deal with high volume of telephone calls
• Ability to effectively deal with constant interruptions
• Data entry and typing skills Microsoft Office software
• Ability to work in EPIC work queues

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health 

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.