Authorization Representative Ortho DME Clinic

Primary City/State:Phoenix, ArizonaDepartment Name:TOCA DME-ClinicWork Shift:DayJob Category:Administrative ServicesGood 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. We’ve united under a common goal: Make health care easier, so life can be better. It’s a lofty goal, but it’s one we’re committed to seeing through. 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. Apply now.TOCA at Banner Health is at the forefront of the Integrated Service Model. We are committed to continually improving our delivery of orthopedic care to meet the needs of our patients. Our Board-certified & Fellow-trained Physicians specialize in: Fracture Care, Joint Replacement, Sports Medicine, Physical Therapy, Hand Therapy, Digital X-Ray, MRI, Bracing & Orthotics, and more By utilizing the most innovative procedures and true state-of-the-art technology, our staff of general orthopedists and sub-specialists have earned a reputation for providing consistent specialized orthopedic care. TOCA’s reputation is built on treating each patient’s specific needs, which is one of reasons why we are the choice of primary care physicians and performance athletes throughout the Valley (Tempe, Scottsdale, Phoenix, and Glendale). We are also honored to be the official team physicians and orthopedic surgeons for Arizona State University.TOCA at Banner strives to push boundaries, challenge the norm, and come up with ways to make health care easy for our patients and for our staff. The clinics are conveniently located off freeway by the Biltmore office. If you are looking to be challenged, work with a large team that is focused on getting the absolute best results for patients, then TOCA at Banner is just the place to start or continue your journey in healthcare. As a Authorization Rep for Durable Medical Equipment , you will be able to use your experiences with responding to patient referrals for tests, procedures, and visits; obtain auths for various payors; authorizes and schedules appointments; and provider necessary information regarding authorizations to staff, patients, third party payors, charge posting, and the billing department. A career with TOCA at Banner is great if you are just starting out; or have many years’ experience. Everyone at Banner contributes to our patients lives! Our team is like a family and we help one another, empower one another to make decisions, and encourage natural talents so each member can grow.Shift Mon-Fri 8:00a-5:00p Will cross cover for PTO at other TOCO sites as needed.POSITION SUMMARYThis 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 FUNCTIONSResponds 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.

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.

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.

Documents and maintains records of all referral activity and authorizations.

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

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.

MINIMUM QUALIFICATIONSHigh school diploma/GED or equivalent working knowledge.Must possess effective verbal and written communication skills.Must be proficient with commonly used office software.PREFERRED QUALIFICATIONSOne 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.Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.