Prior Authorization Specialist

Job Description

Job Description

At Goodman Campbell Brain and Spine (GCBS), every member of our team is essential to fulfilling our mission to deliver exceptional and timely neurosurgical care with a steadfast emphasis on quality.

We work to cultivate an authentic culture through purposeful actions that convey collaboration, respect and a shared vision of excellence. We truly value every interaction we have – with our patients and each other. Our team is at the heart of all we do as an organization, and each employee has the opportunity to enhance the level of service we provide to our patients. We are in search of like-minded individuals, who are pursuing a job of purpose that impacts the lives of patients.

We are seeking a dedicated and capable Prior Authorization Specialist to facilitate the pre-certification process for our patient procedures. The primary responsibilities of this role are updating patient registration information, verification of benefits and authorization/pre-certification for all procedures requiring authorization. This position plays a key role in facilitating patient care and effective information intake for billing and collections purposes. Once fully trained, this position offers the opportunity to be remote.

Outstanding employees in this role are detailed, accurate and efficient while striving to deliver the highest level of service. As this role is an essential part of our team, active communication and respectful collaboration with peers is vital to success. The abilities to multi-task and be flexible are vital to succeed in this role.

Job Duties

1. Pre-Authorization
   1. Obtain required referrals and pre-authorizations for all scheduled appointments, procedures, tests, surgeries, injections and physical therapy
   2. Obtain benefit verification for all Goodman Campbell procedures
   3. Work with Medical Administrative Assistants to schedule tests and complete all required pre-authorizations
2. Patient Registration
   1. Completing unfinished patient registrations.
   2. Scan Insurance Card if not done at front desk.
   3. Obtain any missing information in the chart or registration
3. Responsible for completing required documentation within NextGen regarding authorizations; benefit verification, insurance and patient demographics
4. Update incorrect insurance & demographic information in office practice software as corrections are found in referral and/or pre-authorization process
5. Assist other areas when needed
6. Other duties as assigned

Knowledge, Skills and Abilities Required

• Knowledge of medical insurance plans
• Ability to work independently
• Flexible and able to multi-task
• Exceptional attention to detail
• Ability to collaborate and communicate clearly
• Ability to respectfully interact with physicians, providers, peers and patients
• Outstanding computer and internet skills
• Alignment with HIPAA regulations
• Respect for organizational policies, procedures, systems and objectives

Educational and Experience Required

Education : High school diploma or equivalent

Preferred Experience: 1-3 years hospital or medical office experience, 2 years of medical billing experience preferred.

Physical Demands

Able to sit for an extended period of time in focused work.

Long periods of telephone and computer work.