Authorization Representative Resume Sample
Work Experience
- Three to five years’ experience in a customer service setting; preferably nine months in an ESI call center environment
- Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquiries for continuous improvement
- Conflict resolution skill
- Adapt in a dynamic work environment learns quickly
- Respond to high call volume in a professional efficient manner
- Authorize repair/replacement claims up to $1500
- Interprets and evaluates contract language as it relates to qualifying a claim for coverage
- Analyze claim facts and gather, review, research, and document necessary information in order to determine the best course of action
- Partner with Contractor Relations, Sales Support and Claims Resolution in claim review and decision making for accurate claim closure
- Process cash-settlement offers, contractor dispatch requests, enforce contractor pricing agreements, purchasing of parts and equipment, and communicate claim information to homeowners
- Adhere to established department Methods & Procedures along with call center metrics and Quality Assurance standards
- Place contract warnings and exclusions on systems and appliances to exclude further coverage on an item
- Work under close supervision applying well established techniques, procedures or specific standards. Work is reviewed for soundness of judgment and overall accuracy
- Requests or issues that are not general in nature or that are above approval limits are referred to more experienced team members, Lead or Supervisor
- Does not supervise others
- Using established procedures performs assigned tasks. Work is routine and instructions are usually detailed
- Previous experience with insurance and prior authorizations
- Experience with insurance reimbursement and understanding of policies and benefit information, and the ability to give this information to patients, physicians and office staff
- ICD/CPT Coding Certification
- Expert communication and customer service skills; able to effectively handle irate/dissatisfied customers
- Obtains insurance eligibility and benefit information using various phone and on-line resources
- Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed
- Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe
- Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement
Education
Professional Skills
- Demonstrated good communications and computer skills
- Problem solving skills, analytical ability
- Experience as a medical assistant, office assistant or other clinical experience
- Entry Rate: $13.93 (varies depending on experience)
- Medical Assistant Certification or Healthcare Experience
- Provide excellent customer service in a courteous and professional manner
- Typically has 2-4 years of Customer Service or related experience
How to write Authorization Representative Resume
Authorization Representative role is responsible for government, insurance, education, purchasing, database, training, finance, software, health, communications.
To write great resume for authorization representative job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Authorization Representative Resume
The section contact information is important in your authorization representative resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Authorization Representative Resume
The section work experience is an essential part of your authorization representative resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous authorization representative responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular authorization representative position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Authorization Representative resume experience can include:
- Estimates cost of service using ICD-9 or CPT codes
- Interprets 271 response, including insurance terminology, in online tool to determine patient responsibility
- Coordinates with Case Management on an ongoing basis to initiate 3rd party authorizations as assigned, at the requested level of care. (30%)
- Immediately refers "at risk" admission to eligibility, i.e., out of network, underinsured, max benefits, etc
- Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays
- Maintains a satisfactory level of performance and adherence to workload standards
Education on an Authorization Representative Resume
Make sure to make education a priority on your authorization representative resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your authorization representative experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Authorization Representative Resume
When listing skills on your authorization representative resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical authorization representative skills:
- Working knowledge of collections regulations, including but not limited to Fair Debt Collections Practices Act (FDCPA
- Excessive walking and standing while obtaining patient information when using laptop computer on wheeled device for bedside registration
- KnowledgeSpot training module: Coaching in the Workplace: Coaching for Performance
- Enter authorization meeting daily quota of 45 auths per day into current system using correct types and codes
- KnowledgeSpot training module: Emotional Intelligence
- Performs calculations using insurance benefit information to accurately estimate patient responsibility
List of Typical Skills For an Authorization Representative Resume
Skills For Hwa-authorization Representative Resume
- 5 weeks accrual PTO (paid time off) a year starting on day one
- Complete authorization requests in accordance to the operational procedures outlined within the Operations Manual and Policy Provisions
- Utilize knowledge and guidelines to enter and process authorizations and resolves issues
- Answer phone calls in accordance with departmental standards
- Full benefits package including excellent health insurance (offered through Select Health), HSA, FSA, dental, vision, 401K, pension plan, employee assistance programs, LiVe Well rewards, critical illness, life insurance, tuition reimbursement and much more
- Location Address: 11520 South Redwood Rd, South Jordan UT 84095
- Proficient in Windows applications (Word and Excel)
Skills For Prior Authorization Representative Resume
- Cross train in multiple areas required
- Superior written and verbal communication and
- Utilization of basic mathematical functions
- Sufficient mobility and strength to move around the department and throughout the facility
- Stand or sit for prolonged periods of time
Skills For Credit Authorization Representative Resume
- Gathers and facilitates accurate transfer of patient-related information to insurer and to case manager through interaction with referral sources, patients and medical record review by phone, fax, or online interface as required. (30%)
- Coordinates the transfer of essential patient care information with the inpatient authorization unit to facilitate changes to level of care, as appropriate. (20%)
- Maintains database of insurance payor contacts, including phone numbers, fax numbers, names and the appropriate process to obtain authorizations. (10%)
- Obtains authorizations for complex medication or DME needs on an as requested basis. (5%)
- Extensive use of internal database systems that document calls and progress of case
- Employee wellness program