An Authorization Representative is a representative who interacts with customers and handles their issues, and undertakes the authorization process, and provides them the needed information. While the actual duties vary based on the type of service provided, the following are certain core tasks seen on a professional Authorization Representative Resume – contacting insurances for benefits, eligibility, network status, and authorization; verifying eligibility within the database systems; processing requests for prior authorization; acting as a liaison between the payer and the support staff, and determining coverage and approval criteria.
Even while the type of industry determines the nature of the job for these representatives, the needed skills are almost common and include the following – flexibility and adaptability to quick learning; strong service orientation, the ability to work as a team player; strong computer skills; excellent oral and written communication skills; the ability to handle challenging customers; and strong interpersonal skills. Formal education to a degree level and prior work experience is the best option to enter this career line.
Summary : 5+ years of business, administrative, and customer service experience. Ability to quickly build rapport and establish trust. Recognized for professionalism, positive mental attitude, commitment to excellence, and demonstrated ability to communicate and interact effectively with senior management, associates, and customers.
Skills : Microsoft, Customer Service, Bilingual in English and Spanish.
Description :
Responsible for accurate and timely authorization/pre-certification and verification of benefits with insurance payers.
Performed quality control on new accounts and charge orders.
Obtained daily coversheets or paperwork for accounts to be worked or entered into the billing system working as a team with staff members to ensure the accurate and timely selection of open charge orders.
Reviewed and verified all insurance requests within 24-hours of receipt.
Demonstrate a strong working knowledge of billing system functions to effectively execute job duties.
Possessed strong working knowledge of ICD-10, CPT, and HCPCS codes and HIPAA laws.
Performed computerized scheduling and pre-registration duties by answering phones in the call center providing service to clients and patients by scheduling and confirming appointments, disclosing relevant information regarding billing, exam preparation, directions, etc.
Accurately entered patient's demographics, insurance, and other relevant information into the computer system.
Oversaw the process of incoming patient orders and obtain information necessary to complete the pre-authorization and scheduling of an order.
Experience
7-10 Years
Level
Management
Education
Associates
Authorization Representative Resume
Summary : Experienced in general office principles, practices, and procedures. Proficient in MS Office: Excel, Word, PowerPoint. Detail-oriented, proficient organizer with the ability to delegate and train others. Talented in bringing forth innovative ideas in order to increase efficiency. CompTIA A+ Certified computer technician.
Answered incoming calls from service technicians - average 50 per day - Processed calls regarding a customer's work order claim.
Took diagnosis and cost estimate and either authorized repair or determined what other options need to do.
Created and updated Excel spreadsheets and tip sheets to Authorizers to enable them to easily make decisions and quickly calculate costs for repairs.
Tutored and mentored other agents in making decisions on a claim and best practice methods.
Received award for most Innovated.
Answered Customer Service Representative's calls and assisted them in resolving difficult issues.
Took customer escalation calls when the need for more advanced call handling and thinking outside the box was required.
Assisted supervisors in monitoring agent's real-time stats to determine if they may need assistance with a call, taking too long a break or longer than the usual time between calls.
Walked the service area in order to assist those who may need help on a call or any other issue.
Experience
10+ Years
Level
Senior
Education
HS Diploma
Authorization Representative Resume
Objective : Knowledgeable of HIPAA Laws and regulations Basic computer skills including Microsoft Office and Exceptional communication, customer service, and problem-solving skills Ability to manage and lead a team successfully able to explain complex problems and situations so they are easily understood.
Skills : Microsoft Office, Excel, Managing Skills.
Description :
Determined coverage and make repair/replacement decisions that are in the best interest of the company.
Resolved claims accurately and expeditiously by balancing the Company's contractual obligation by providing a high level of customer service.
Responded to a high volume of Claims Authorizations requests in a professional and efficient manner.
Analyzed claim facts and, gather, review, research, and document necessary information in order to determine the best course of action.
Authorized repair/replacement claims.
Obtained Management approval for claim denials pertaining to pre-existing conditions, improper installations, and lack of maintenance and for second-opinion dispatch requests.
Interpreted and evaluated contract language as it relates to qualifying a claim for coverage.
Processed cash-settlement offers, contractor dispatch requests, enforce contractor pricing agreements, and communicate claim information to homeowners.
Placed and lift contract exclusions.
Experience
2-5 Years
Level
Junior
Education
Diploma in General
Authorization Representative Resume
Objective : Authorization Representative with a proven capacity to troubleshoot issues to ensure customer satisfaction. Highly experienced in a high call volume environment with superior computer and customer service skills. High customer service standards Conflict resolution proficiency Strong organizational, writing, and verbal skills Knowledge of electronic health record database maintenance with a high level of problem-solving skills.
Skills : Proficient In Microsoft Office, Office 365, Windows 10, Type 50+ Wpm, Knowledge And Understanding Of HIPAA Regulations.
Description :
Provided assistance to providers and members or their representatives via telephone or correspondence concerning eligibility, selection of primary care physicians, and claims.
Answered a high volume of inbound calls in a prompt, professional, courteous, and helpful manner.
Screened and directed calls to appropriate staff members/departments.
Responded to routine requests for information on eligibility and coverage.
Demonstrated comprehensive knowledge of Health Plan Benefits and the various departmental functions.
Analyzed and identified concerns/issues and referred them to the appropriate department when necessary.
Assisted physicians with obtaining prior authorizations for various imaging procedures from patients' health carriers.
Worked closely with numerous insurance carriers.
Received and processed all incoming referrals within established turnaround times.
Experience
0-2 Years
Level
Entry Level
Education
Associates of Arts in Health Care Administration
Authorization Representative Resume
Objective : Utilizing proven Anthropology, cultural and leadership skills, training, and experience while contributing to the success of a company that values sales and customer service.
Skills : CPT and ICD-9 Coding, Athena, Microsoft Office. BRHC, RQI Supervisor.
Description :
Documented detailed diagnosis' of malfunctions with appliances and systems in customer's homes.
Made a coverage decision based on the diagnosis and the customer's contract.
Authorized the tech for a specific amount of money in order to complete the repair or replacement.
Created made suggestions as to how to bring our team together so that we would be able to function on a more productive level as a group.
Took on leadership roles while in training with my current team.
Demonstrated interviewing skills when getting a diagnosis from technicians.
Displayed writing skills in numerous emails that had to be sent to different supervisors and other reps within the company.
Experience
2-5 Years
Level
Junior
Education
BA in English
Authorization Representative Resume
Objective : Authorization Representative works with the team to define, prioritize, and negotiate policies for approved user access on behalf of the company. The role involves defining, prioritizing and negotiating access policies for users, vendors and contractors. This includes writing policies and procedures to ensure compliance with company standards and requirements.
Skills : Billing, Bilingual Spanish, Collections, Computer Literate, Data Entry, Emr, Knowledge Of Medical Terminology, Quality Control.
Description :
Insurance verification, verifying physician orders/referrals for accuracy.
Obtained prior authorization for exams being ordered by physicians.
Assisted doctor's offices and patients with questions prior to the visit.
Contacted insurance companies and patients.
Proficiently operated multi-line phone systems in a high-volume call environment.
Checked to ensure that appropriate changes were made to resolve any issues.
Exceptionally communicated with colleagues and customers.
Experience
2-5 Years
Level
Junior
Education
Medical Office Administration
Authorization Representative Resume
Objective : Highly analytical Prior Authorization Analyst with proven years of experience; extremely motivated and a very keen individual with expertise; highly articulate and effective communicator; works well with individuals on all levels; distinguished as a team player, problem solver and a resourceful person.
Skills : Microsoft Outlook, Excel, Medical Terminology, Office Equipment, Medical Records, Front Office, Receptionist, Authorizations/Referrals, Customer Service.
Description :
Worked taking phone calls from Merchants who needed authorizations on credit cards and bank checks.
Called out to issuing banks for some of the authorizations.
Also provided bank numbers and assistance for Merchants when they had questions concerning their accounts.
Transferred Merchants to proper departments and transferred to banks as well.
Assisted in code cancelations and worked on numerous screens on the computer.
Had to fill out faxes that needed to be faxed to banks for the merchants and provided information for credit cards on which bank it was issued from.
Gathered information from Contractors to determine the status of warranty claims.
Experience
2-5 Years
Level
Junior
Education
Diploma
Authorization Representative Resume
Headline : Goal-oriented management Authorization Representative professional with excellent organizational and interpersonal skills seeks opportunities to contribute expertise while working for a reputable organization.
Skills : Maintenance, Microsoft Office.
Description :
Received pre-authorization requests for designated ASO accounts from referring physician offices via telephone, utilizing the Informa system.
Referred cases to the clinical/medical department for review when appropriate.
Reviewed Nurse or Medical Director to process the request.
Received and handled general information requests via telephone and facsimile from various external sources.
Contacted referring physician's offices, members, and imaging providers via telephone in order to communicate authorization approvals.
Contacted referring physician's offices via telephone in order to communicate denied authorizations due to lack of health plan eligibility, verify all member information for accuracy.
Directed cases and/or calls requiring additional action to the appropriate department for follow-up.
Experience
5-7 Years
Level
Executive
Education
Diploma
Authorization Representative Resume
Summary : Highly qualified Authorization Representative with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and would excel in the collaborative environment on which your company prides itself.
Skills : Microsoft Word, Excel, Access, PowerPoint, and Publisher. Cash Handling, Filing, Data Entry, Inventory, Customer Service, and Sales.
Description :
Received and processed requests (via telephone call) from various health care offices and facilities requesting authorization for inpatient and outpatient services and procedures.
Gathered and investigated critical patient health history while abiding by all applicable HIPAA privacy guidelines.
Forwarded request to the clinical staff which included an RN.
Provided training for newly hired staff members in the proper collection and documentation of patient health history to ensure that the proper authorizations were obtained.
Performed QI Reviews for staff/team members.
Offered constructive feedback in assisting team authorization members in gathering the proper patient health histories and obtaining correct levels of authorizations based on this information.
Responded to the high volume of inbound calls for radiology services.
Experience
10+ Years
Level
Senior
Education
Certificate in Medical Triage Training
Authorization Representative Resume
Objective : Looking to work with a leading healthcare facility using my skills to improve business office success and performance while learning and developing knowledge to seek advancement in the company.
Skills : Springer-Miller Systems, Microsoft Excel.
Description :
Received pre-authorization requests for radiology procedures for designated health plans from referring physician offices via telephone, utilizing the Informa System.
Referred cases to the clinical/medial dept. for further review when appropriate.
Received verification requests from rendering providers via telephone.
Verified registration information and logged verification data in the database.
Received and handled general information requests from various external sources such as healthcare providers, health plans, and health plan members.
Received and responded to complaints about the authorization process, and resolved issues whenever possible, or referred them for the solution.
Maintained a log of all telephone interactions with referring/rendering providers.
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