Prior Authorization Associate Jobs in Jackson, MS

Description

Job Summary:

The Patient Access Representative is responsible for greeting patients, verifying insurance information, registering patients for services, collecting payments, scheduling appointments, and maintaining accurate patient records, all while ensuring the integrity of the Master Patient Index. The Patient Access Representative ensures a smooth and welcoming experience and adheres to all regulatory and confidentiality standards. Strong communication, customer service, and organizational skills are essential for success in this role.

Knowledge, Skills, and Abilities:

Basic knowledge of patient throughput workflows and regulations. Proficient in revenue cycle healthcare systems. Ability to maintain confidentiality. Intellectual capacity to understand and analyze complex payer guidelines and proper patient access regulations. Demonstrated analytical skills to discover root cause of errors and properly correct. Good verbal and written communication skills. Maintains professional standards. Effective organizational skills. Basic computer skills, including but not limited to proficiency in Microsoft Word and Excel, and basic data entry.

Responsibilities:

• Greet and assist patients, families, and visitors in the Emergency Room with professionalism, empathy, and a sense of urgency.
• Complete timely and accurate patient registration, including collection and verification of demographic, insurance, and financial information.
• Obtain necessary patient signatures on consent forms, privacy notices, and financial documents, ensuring compliance with hospital and legal requirements.
• Verify insurance eligibility and benefits using electronic tools or direct contact with payers, and update records accordingly.
• Determine and collect patient co-pays, deductibles, or deposits as appropriate; provide information about financial assistance programs when needed.
• Collaborate with clinical and security teams to prioritize patient intake based on acuity and maintain efficient patient flow.
• Accurately enter and maintain patient data in the electronic medical record (EMR) and registration systems, correcting duplicate records or errors as necessary.
• Respond promptly and courteously to patient and family inquiries, demonstrating sensitivity to diverse situations and emotional states.
• Stay informed on payer guidelines, hospital policies, and Emergency Department protocols to ensure compliance and accuracy.
• Support process improvements and assist in training new staff when applicable; provide backup assistance to other Patient Access areas during high-volume periods.
• Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands:

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, no activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, occasional lifting/carrying up to 50 pounds, occasional lifting/carrying up to 75 pounds, occasional lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, occasional driving, occasional kneeling, occasional pushing/pulling, frequent reaching, frequent sitting, frequent, standing, occasional twisting, and frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Requirements

Education and Experience: High school diploma or GED required. Four (4) or more years of relevant experience in Admissions, Patient Registration, Scheduling, Insurance Verification, Pre-Registration, Collections, Prior Authorizations, Payor Authorizations and/or Call Center, with a proven track record of accomplishing high quality work in a professional manner, or three (3) years relevant experience in Admissions, Patient Registration, Scheduling, Insurance Verification, Pre-Registration, Collections, Prior Authorizations, Payor Authorizations and/or Call Center and hold certification as a Certified Healthcare Access Associate (CHAA) through National Association of Healthcare Access Management (NAHAM).

Certifications, Licenses or Registration Required: N/A

Preferred Qualifications:

Knowledge of ICD-10/HCPCS/CPT coding

Basic knowledge of third-party insurance and government insurance plans