Authorization Representative - Clinic

The Authorization Representative is responsible for ensuring patients are properly cleared for hospital services, specialty care, and office visits. This role resolves pre‑certification, registration, and case‑related issues while determining patient financial obligations prior to scheduled services. The Authorization Representative works closely with insurance carriers, financial counselors, specialists, and ancillary departments to support a smooth patient experience.

Key responsibilities include accurately verifying patient information, providing exceptional service, and maintaining a best‑in‑class experience for every patient. This position follows established guidelines, relying on experience, sound judgment, and general supervision to successfully perform daily tasks.

     

1. Customer Service
   1. Gathers information from the chart and clinic personnel regarding insurance coverage and reason for the procedure.
   2. Gathers information from the chart and clinic personnel regarding insurance coverage and reason for the procedure.
   3. Relays authorization approval, peer to peer request or denial status to the clinic personnel and physician timely to facilitate patient care.
   4. Accurately and efficiently processes referrals to specialists, hospitals and diagnostic centers in accordance with physician orders processing referrals in a timely manner for required services in the most appropriate setting; coordinates the referrals with insurance providers so that financial liability to the patient is minimized.
   5. Obtains/scans outside clinic records after patient appointment with specialist to assure continuity of care.
2. Quality
   1. Utilizes available resources to determine if physician is participating with patients' insurance plan. Ensures lists of doctors and needed items are updated and modified as necessary.
   2. Attends meetings as required and participates on committees as directed. Strives to improve the quality of meeting by taking an active role in meeting topics.
   3. Assures that authorizations are obtained prior to date of service for 99 % of cases scheduled.
   4. Schedules are reviewed prior to date of service to assure that authorization numbers have been obtained for all procedures that require one.
   5. Scans authorization confirmation/denials into chart in a timely manner to facilitate claims processing should issues arise.
3. Financial
   1. Responsible for the verification of insurance information, as well as documenting the need for authorization or lack of need for authorization in the computer system to facilitate claims processing.
   2. Contacts insurance carriers to secure authorization information. Documents authorization information in the computer system to ensure visits are approved.
   3. Acts as a resource for the department personnel as it relates to the authorization process and documentation required for services.
4. Other Duties as Assigned
   1. Performs other duties as assigned or requested.

Experience: 1 year experience in medical office or hospital setting

Education: High School or equivalent

Special Skills: Basic clerical and computer skills

FMOL Health is a leading health care innovator in Louisiana and Mississippi. We bring together outstanding clinicians, the most advanced technology and leading research to ensure that our patients receive the highest quality and safest care possible.

This commitment is grounded in a history that is more than 100 years old, but reflected today by our strategic vision of transforming healthcare through superior performance and excellent patient care.
In the last fiscal year, FMOL Health had:

• 1,747 Licensed Beds
• 65,322 Discharges
• 44,592 OR Procedures
• 10,827 Full Time Employees
• 331,360 Inpatient Days
• 1,915 Active Medical Staff
• 229,296 Emergency Visits

As a nonprofit, mission-focused Catholic healthcare ministry, we give special attention to our citizens who are most in need. During the most recent fiscal year, we provided more than $39 million in unreimbursed care and community support to the underprivileged.

Our health system is one of the largest in Louisiana, with hospitals, clinics and physicians located throughout Louisiana and in Mississippi. In fact, we provide care to almost half of Louisiana’s citizens, and serve in Mississippi's largest metropolitan area. Because of our size and the partnerships we have with other local organizations, we are able to pool our resources and share cost and service efficiencies and learn from each other, thereby accelerating our ability to improve care and solve challenges.

Since our founding in Monroe, Louisiana in 1911, we have been blessed by the guidance of the Franciscan Si