Prior Authorization Specialist

Job Description

Job Description

Overview

Under the direct supervision of the Customer Care Manager , the Prior Authorization Specialist is responsible for obtaining pre-authorizations for medications and diagnostics, scheduling patients for outpatient testing and coordinating patient orders. 

Candidate qualifications:

Licensure/Certification: None

Education: High School Diploma Required

Experience: Previous experience in a clinic setting preferred.

Knowledge/Skills: Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data. Requires good judgment, tact, diplomacy, and ability to problem solve. Able to work effectively in a team environment. Able to use a personal computer and related software.

Minimum Qualifications: Must be able to sit, stand and walk for long periods of time. Able to read and understand the English language. Able to effectively maintain confidentiality of records and communicate with all levels of personnel.

Job Responsibilities: 

• Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
• Request, track and obtain prior authorization from insurance carriers within time allotted for medical services.
• Request, follow up and secure prior authorizations prior to services being performed.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Communicate any insurance changes or trends among team.
• Maintains a level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Other duties as assigned.

Kintegra Health Core Requirements

1. Patient First –  An approach to care that holds primary, the well-being and desires of the patient

2. Build not Blame –  Focusing first on finding fault with the process rather than the person

3. Integrity and Honesty – Fostering an acceptance of openness, honesty, and fairness in words, deeds and the use of organizational resources  judiciously for both internal and external customers

4. Cooperation and Flexibility –  Related to an internal believe that we function as part of an interdependent team with only shared gains or losses thereby committed to assisting whenever possible beyond the prerequisite job description

5. Culturally Sensitive –  Always working toward increasing one’s ability to understand, communicate with, effectively interact and care for people across cultures, while having an acute awareness of one’s own culture.