Prior authorization representative vs registration representative

Differences between prior authorization representative and registration representative duties and responsibilities

Prior authorization representative example responsibilities.

• Manage inbound/outbound calls for medical personnel and patients, along with computerize data entry to regulate proper distribution of prescription medication.
• Utilize knowledge of physician office policies, CPT and ICD-9 coding, procedures, and equipment.
• Provide compassion without judgment in regards to patient's finances.
• Determine if CPT and ICD-10 codes are correct and qualify for coverage.
• Review all daily EDI reports to make sure claims are being accept properly.
• Perform chart audits via EMR, prepare medical records for subpoenas, general requests.
Show more

Registration representative example responsibilities.

• Work with third party payer requirements including Medicare, Medicaid (AHCCCS), manage care plans, and commercial plans.
• Manage and update demographic and insurance information, including authorizations and referrals, while demonstrating HIPPA confidentiality regulations.
• Verify eligibility and insurance benefits for patients, including Medicare, Medicaid, private insurance and workers' compensation.
• Maintain patient privacy in accordance with HIPAA with a high level of professionalism, compassion, productivity, and accuracy.
• Maintain proficient level of knowledge regarding Medicare requirements, HIPAA compliance and reimbursement criteria.
• Complete registration process for inpatients, outpatients, and emergency patients accurately and efficiently in accordance with policies and procedures.
Show more