What does an authorized representative do?
An authorized representative's primary role is to represent an individual or company in different official transactions. They have the authority to communicate, liaise, negotiate, and make decisions according to goals and project requirements. Although most authorized representatives have varying responsibilities depending on their company of employment, it usually includes understanding project needs, liaising with internal and external parties, preparing and processing documents, organizing files, handling calls and correspondence, and monitoring the transactions' progress. Moreover, as an authorized representative, it is essential to be proactive at dealing with issues, resolving them promptly and professionally.
Authorized representative responsibilities
Here are examples of responsibilities from real authorized representative resumes:
- Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
- Audit requests to ensure that proper ICD-9 and CPT coding are applied.
- Research coordinator and referral coordinator, obtain insurance authorization and provide information to insurance carriers or patients regarding patient accounts.
- Verify (CCS), CHDP, HMO, PPO authorizations.
- Adhere strictly to HIPAA privacy guidelines.
- Scan Medicaid coverage in to patient's electronic file.
- Create the template for CPT handbook used by Pre-Authorization department.
- Cooperate with medicaid, commercial & private providers; establish relationships; resolve billing issues.
- Obtain and document diagnosis and procedure codes using CPT-4, ICD-9 and HCPCS code books.
- Work collaboratively with associates and supervisors to ensure that best practices are share and keep confidential under HIPAA guidelines.
- Review patients accounts, verify information, update accounts, and communicate with other department to ensure accurate information is accessible.
- Maintain all authorization/notification relate faxes and other documentation in order to support the appeals process if a claim denial is received.
- Utilize Meditech MOX communication system to facilitate communication with hospital gatekeeper.
Authorized representative skills and personality traits
We calculated that 24% of Authorized Representatives are proficient in Patients, Medical Terminology, and Insurance Verification. They’re also known for soft skills such as Communication skills, Computer skills, and Customer-service skills.
We break down the percentage of Authorized Representatives that have these skills listed on their resume here:
- Patients, 24%
Reviewed patients accounts, verified information, updated accounts, and communicated with other department to ensure accurate information is accessible.
- Medical Terminology, 11%
Be proficient in medical terminology in order to explain denied cases, reconsideration options and the appeal processes.
- Insurance Verification, 7%
Document insurance verification and precertification for ABA, Speech and Occupational Therapy services.
- CPT, 5%
Collected all the demographics, CPT Codes, ICD-9 codes, and verified all information on the faxes.
- Insurance Authorizations, 5%
Obtained insurance authorization, managed all insurance coping and billing with absolute accuracy to insure efficient payment.
- Data Entry, 4%
Performed data entry of utilization, authorization, and referrals.
"patients," "medical terminology," and "insurance verification" are among the most common skills that authorized representatives use at work. You can find even more authorized representative responsibilities below, including:
Communication skills. To carry out their duties, the most important skill for an authorized representative to have is communication skills. Their role and responsibilities require that "customer service representatives must be able to provide clear information in writing, by phone, or in person." Authorized representatives often use communication skills in their day-to-day job, as shown by this real resume: "assist contractors via inbound and outbound and electronic communication according to all ahs policies, procedures, and contract coverage. "
Customer-service skills. authorized representatives are also known for customer-service skills, which are critical to their duties. You can see how this skill relates to authorized representative responsibilities, because "representatives help companies retain customers by professionally answering questions and helping to resolve complaints." An authorized representative resume example shows how customer-service skills is used in the workplace: "responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims. "
Interpersonal skills. For certain authorized representative responsibilities to be completed, the job requires competence in "interpersonal skills." The day-to-day duties of an authorized representative rely on this skill, as "representatives should be able to create positive interactions with customers." For example, this snippet was taken directly from a resume about how this skill applies to what authorized representatives do: "received recognition from nurses for exceptional interpersonal skills with patients. "
Listening skills. Another common skill required for authorized representative responsibilities is "listening skills." This skill comes up in the duties of authorized representatives all the time, as "representatives must listen carefully to ensure that they understand customers in order to assist them." An excerpt from a real authorized representative resume shows how this skill is central to what an authorized representative does: "communicated information as required to insurance carriers through computerized and phone data entry, or written forms. "
Patience. While "patience" is last on this skills list, don't underestimate its importance to authorized representative responsibilities. Much of what an authorized representative does relies on this skill, seeing as "representatives should be patient and polite, especially when interacting with dissatisfied customers." Here is a resume example of how this skill is used in the everyday duties of authorized representatives: "advise patients and families of hospital policies and procedures with courtesy and patience. "
The three companies that hire the most authorized representatives are:
- Cleveland Clinic11 authorized representatives jobs
- Triple-S5 authorized representatives jobs
- Baptist Health Home Care5 authorized representatives jobs
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Compare different authorized representatives
Authorized representative vs. Insurance verification specialist
An insurance verification specialist is responsible for confirming a patient's insurance details and eligibility to receive medical care services. Insurance verification specialists review the insurance documents of the patients, including its coverage and limitations, and escalate concerns to the supervisor for immediate resolution. They process paperwork accordingly upon coordinating with the patients and attending health professionals. An insurance verification specialist must have excellent communication and organizational skills, finishing administrative tasks efficiently under minimal supervision.
These skill sets are where the common ground ends though. The responsibilities of an authorized representative are more likely to require skills like "insurance coverage," "insurance benefits," "hvac," and "quality customer service." On the other hand, a job as an insurance verification specialist requires skills like "customer service," "health insurance," "phone calls," and "patient insurance coverage." As you can see, what employees do in each career varies considerably.
Insurance verification specialists really shine in the pharmaceutical industry with an average salary of $35,651. Comparatively, authorized representatives tend to make the most money in the insurance industry with an average salary of $36,913.The education levels that insurance verification specialists earn slightly differ from authorized representatives. In particular, insurance verification specialists are 1.7% less likely to graduate with a Master's Degree than an authorized representative. Additionally, they're 0.2% less likely to earn a Doctoral Degree.Authorized representative vs. Patient service coordinator
Patient services coordinators act as a liaison between a healthcare organization and patients. Their primary job is to provide quality service to patients. Their duties and responsibilities include fielding telephone calls from patients, assessing patients' issues, and interacting with team members, medical personnel, and employees from other departments. Also, they are responsible for ensuring compliance with regulatory and hospital requirements and maintaining quality service. Patient services coordinators must also ensure to maintain their technical knowledge by participating in personal networks, attending educational workshops, and reviewing professional publications.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that authorized representative responsibilities requires skills like "authorization process," "hvac," "quality customer service," and "plumbing." But a patient service coordinator might use other skills in their typical duties, such as, "customer service," "patient care," "front desk," and "patient flow."
On average, patient service coordinators earn a lower salary than authorized representatives. Some industries support higher salaries in each profession. Interestingly enough, patient service coordinators earn the most pay in the health care industry with an average salary of $35,469. Whereas authorized representatives have higher pay in the insurance industry, with an average salary of $36,913.patient service coordinators earn similar levels of education than authorized representatives in general. They're 0.6% more likely to graduate with a Master's Degree and 0.2% less likely to earn a Doctoral Degree.Authorized representative vs. Patient service specialist
A patient service representative serves as a patient's primary point of contact in a hospital or clinic, ensuring accuracy and customer satisfaction. They are mainly responsible for gathering a patient's information and medical history, verifying insurance forms, managing accounts, and processing payments, arranging appointments, and even performing reminder calls and correspondence. There are also instances when a patient service representative must discuss situations to patients and their families, and even alert the doctors when a patient displays strange or unlikely behavior.
The required skills of the two careers differ considerably. For example, authorized representatives are more likely to have skills like "authorization process," "hvac," "quality customer service," and "plumbing." But a patient service specialist is more likely to have skills like "patient service," "rehabilitation," "front desk," and "office equipment."
Patient service specialists earn the highest salary when working in the health care industry, where they receive an average salary of $33,449. Comparatively, authorized representatives have the highest earning potential in the insurance industry, with an average salary of $36,913.When it comes to education, patient service specialists tend to earn similar degree levels compared to authorized representatives. In fact, they're 0.2% more likely to earn a Master's Degree, and 0.1% more likely to graduate with a Doctoral Degree.Authorized representative vs. Registration specialist
A registration specialist is responsible for managing patient information, including the verification of their insurance details and medical treatment schedules. Registration specialists assign admission rooms and processing payments for discharge. They also assist patients with the completion of medical forms by helping them fill-out papers with the most accurate information. A registration specialist performs administrative and clerical duties as needed, requiring them to have excellent data management skills to process information and provide the highest quality care services for the patients.
Types of authorized representative
Updated January 8, 2025
