The Pre-Authorization and Referral Representative verifies insurance on-line and over the phone, obtains referrals and authorizations for Fairview Rehabilitation Services (FRS) patients as outlined by each individuals insurance. This position is responsible for tracking/correcting all pertinent insurance information into Epic. They are responsible for providing clinics/patients with the most accurate data as it pertains to receiving services with FRS.
This position is located at our Kasota office in Minneapolis, MN. It is a full time, 80 hour per two week pay period position that is benefit and PTO eligible.
Works with insurance companies to make sure that pre-authorization and referral requirements are met assuring FV of maximum reimbursement and minimal denials
Uses excellent telephone etiquette and active listening skills.
Identifies insurances for all new patients that require information/notification from the site for new, continuing, and observation patients.
Documents and tracks all communication with insurers, clinics and patients. Documents each step taken in process of obtaining authorization or confirmation of compensability determination. Documents pertinent information for therapist use in contacting insurance carrier if further authorization is necessary.
Enters referrals with all pertinent information into Epic referral entry.
Initiates process to establish company account for workers compensation patients and all other insurances as needed.
Informs patients/clinic/caregiver of denials by insurance companies when pre-authorizing services. Contacts patients with insurance issues such as termed insurance
Develop a list of key contacts at insurance companies and develop positive working relationships to facilitate ability to retro-authorize claims and maximize reimbursement.
Assists in training new insurance staff
Obtains insurance referrals from PCC if required by insurance
Obtains approval from homecare/SNFs for Medicare patients who are under Medicare Part A episodes
Submits appeals to insurances
Incorporates new changes in insurance verification
Adapts to changes in volume of workload
Works with Fairview CBO departments and insurance companies to make sure that insurance information is correct. Completes patient insurance verification process
Verifies patient insurance information on-line or by phone. Verifies insurance eligibility via online access or by phone. Verifies insurance for new patients as well as re-verifies insurance throughout the year for designated rehab locations
Enters demographic and insurance information changes into EPIC.
Make sure guarantor accounts with attached insurances have been set up correctly in Epic
Provide feedback to supervisor on clinics that need additional training due to high level of errors.
Provides documentation for denial of payment issues
Keeps proper documentation to insure that maximum payment is obtained
Correctly identifies errors and corrects them in Epic Work Queues.
Identifies staff with training needs based on quantity of errors.
Minimum Qualifications to Fulfill Job Responsibilities:
Vocational/Technical Training or Associates Degree
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider netwo...rk and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.