Prior Authorization Specialist

Job Description

Job Description

Description:

Florida Neurology Group has openings for full-time Prior-Authorization Specialists working on pre certifications for infusions/Botox. This position includes verification of insurance benefits as it applies to the pre-certification process, obtaining pre-certification and pre-authorization from payers, and counseling patients regarding their financial obligation with regard to the testing/treatment being scheduled, etc.

RESPONSIBILITIES:

• Collects and reviews all patient insurance information and submits prior-authorization form.
• Authorization Specialist are responsible for all aspects of benefit verification and authorization
• Authorization Specialist ensures that FNG meets patient's insurance requirements for reimbursement prior to testing or treatment.
• Obtains necessary pre-authorizations from payer.
• Communicate with physician/clinical staff any pre-certification or PA requirements by the patient's insurance carriers.
• Ensures up-to-date documentation on patient's account in Electronic Medical
• Record related to authorization approvals and denials.
• Works with specialty pharmacies as required by patient's insurance carrier to set up order and delivery of medication.
• Maintains updated referrals and authorizations.
• Communicates with ordering physician and/ or APP in the case of denials that will require rescheduling and/or peer-to-peer review by the ordering physician.
• Contacts patient to notify of termed insurances.
• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.

KNOWLEDGE, SKILL AND EXPERIENCE

• Previous experience in pre-authorization/pre-certification and processing of health insurance claims
• Knowledge of insurance and third-party payers
• Previous experience with CPT and ICD-10 coding
• Basic computer knowledge and keyboarding skills
• Medical terminology
• Excellent communication skills
• Customer service experience
• Strong organizational skills
• Detail-oriented
• Ability to multi-task and work well in a fast-paced setting
• Critical thinking skills and decisive judgment
• EMR/ EPIC

Benefits:

• 401 (k)
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance