You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking an experienced Authorization Representative to manage pre-certification requests, verify insurance, and communicate effectively with both patients and physicians. This role will be primarily responsible for ensuring surgical procedures are authorized prior to the date of service and preventing front-end denials.

Key Responsibilities

• Authorization Management: Track and manage pre-certification requests through payer portals to ensure all surgical procedures are approved prior to the date of service.
• Insurance Verification: Confirm patient eligibility and benefits, specifically identifying deductibles, coinsurance, and out-of-pocket maximums.
• Clinical Liaison: Collaborate with physician offices to ensure authorization is in place in time for the patient's procedure.
• Denial Prevention: Proactively manage pending approvals and follow up with offices in regards to next steps to prevent front-end denials.
• Compliance & Coordination: Ensure all activities meet insurance policy regulations and coordinate with Health Care Industry Representatives (HCIR) for operating room requirements when necessary.
• Front End Collections: Collect and explain patient responsibility for procedures and be able to have "tough conversations" on outstanding patient balances.
• Financial Communication: Clear communication with patients regarding their authorization status and anticipated financial responsibilities, and clear communication with physician offices regarding medical necessity for various procedural recommendations.

Qualifications

• Technical Knowledge: Deep understanding of medical terminology, ICD-10/CPT coding, and general insurance terminology.
• System Proficiency: Expertise in Electronic Health Record (EHR) systems and navigating various payer web portals.
• Industry Experience: 1-3+ years of direct experience in insurance verification or authorizations within a clinical or administrative business office environment.
• Professional Communication: Ability to negotiate effectively with insurance carriers and maintain professional relationships with healthcare providers.

Skills

• Technical skills: Medical terminology, ICD-10/CPT coding, insurance terminology.
• Soft skills: Professional communication, negotiation with insurance carriers.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.