Full-Time Authorization & Eligibility Representative

About the position

Join Ashe Memorial Hospital – Ashe’s Best Place to Work! At Ashe Memorial Hospital, we are driven by our mission: “To meet the needs of the community by delivering patient-centered, high quality health care.” Ashe Memorial Hospital is proud to have been voted Ashe’s Best Place to Work in 2022, 2023, 2024, and 2025. Join a team recognized throughout the community for excellence in healthcare, including awards for Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice. This is your opportunity to make a meaningful difference in a close-knit mountain community.

Responsibilities

• Utilizes work list to contact appropriate utilization management company or insurance payer to request authorization where company can obtain.
• Sends timely requests to referring physicians for authorization numbers where company cannot obtain.
• Communicates authorization cases denied for medical necessity or requiring peer to peer review to the referring physician for resolution.
• Validates all authorizations for accuracy prior to exam.
• Follows up on all pending authorizations with the appropriate entity. Forward correspondence to offices for exams on their daily schedule.
• Documents authorization in scheduling system according to defined protocol.
• Answers incoming calls from offices, referring physicians and patients regarding authorization requirements and status.
• Answers incoming calls from patients to provide an estimate of our of pocket cost after insurance processing prior to exam.
• Arranges appropriate date/time based on patient needs and exam being scheduled when patient calling for price quote elects to have procedure performed.
• Responsible for contacting patients directly to reschedule the exam if authorization is not obtained prior to appointment time.
• Executes eligibility searches using available applications.
• Researches eligibility exceptions to locate missing information or determine if there is an absence of coverage.
• Provides excellent customer service with all customers.
• Adheres to referring physician requested protocol regarding authorization requests.

Requirements

• High school diploma or GED
• 1+ year healthcare experience preferred
• insurance authorization experience a plus
• Strong communication and organizational skills
• Fully vaccinated for COVID-19 and other required immunizations.

Benefits

• 1st shift, Monday–Friday
• No nights or travel
• Pay commensurate with experience
• Benefits start the 1st of the month following employment