Prior authorization specialist vs patient access representative

Differences between prior authorization specialist and patient access representative duties and responsibilities

Prior authorization specialist example responsibilities.

• Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
• Manage quality communication, patient support and service representation with patients and providers to establish equipment/procedures statuses and expedite orders.
• Work with staff to ensure proper CPT codes are submit on authorization request.
• Demonstrate compassion while obtaining patient demographics and personal health information.
• Register patients into the emergency department or outpatients for surgery or procedures.
• Register patients' demographics and insurance information; execute daily outpatient and surgery reports.
Show more

Patient access representative example responsibilities.

• Use EMR software to manage patient records and files; reinforce and uphold patient confidentiality as required by HIPPA and clinic.
• Conduct intensive screening of all Medicare, Medicaid and manage care patients for provider service eligibility.
• Educate eligible applicants about Medicaid manage care and how to access benefits in a manage care environment.
• Run internal reports to ensure ICD 9 and CPT procedure codes are accurate for billing for Medicare and Medicaid patients.
• Deliver quality customer service and compassion while obtaining demographic and financial data from patients seeking emergency medical services.
• Operate front desk check-in, preparation of charts, receive payments and balance books at the end of the day.
Show more