Specialty Prior Authorization Coordinator

The Prior Authorization Coordinator is responsible for obtaining and renewing authorizations for medical and/or pharmacy payors. Additional responsibilities include preparing paperwork and documentation required for billing and collections and working with other departments as necessary to facilitate accurate and timely payment of claims. Initiates Prior Authorizations, Pre-Certifications, Pre-Determinations and Advanced Benefit Determination requests for new and existing patients. Performs pharmacy test claims and follow-up regarding results. Work on patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance. Work with physician offices to facilitate the process of obtaining prior authorization from third party payers in order to maximize patients' access to treatment. Help support the appeal process to overturn insurance denials and/or benefit exclusions when needed. Works with Intake, Billing and Collection teams to resolve claims issues. Maintains confidentiality of all PHI in compliance with state and federal law. Other duties may be assigned. Education and Experience High School Diploma or equivalent Preferred: Meet state requirements of national certification (CPhT) or other board approved training program, if required by state. Previous Prior Authorization and Claims experience is preferred Knowledge, Skills, and Abilities Demonstrates a high degree of personal responsibility regarding accuracy and quality of work. Demonstrates ability to work effectively and maintain expected productivity. Ensures accuracy of information being provided to Management for review. Schedules own time based on priorities. Demonstrates Excellent customer service and Professionalism Ability to multi-task Ability to communicate effectively, patiently and courteously. Ability to work in a high pace, stress environment. Should be independent and self-motivated. Maintains a good attendance record. Work Environment / Physical Demands This position is in a typical office environment which requires prolonged sitting and standing in front of a computer. In addition, this position requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including the operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients and employees. This position may be required to work long hours. The Prior Authorization Coordinator is responsible for obtaining and renewing authorizations for medical and/or pharmacy payors. Additional responsibilities include preparing paperwork and documentation required for billing and collections and working with other departments as necessary to facilitate accurate and timely payment of claims. Essential Duties & Responsibilities Initiates Prior Authorizations, Pre-Certifications, Pre-Determinations and Advanced Benefit Determination requests for new and existing patients. Performs pharmacy test claims and follow-up regarding results. Work on patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance. Work with physician offices to facilitate the process of obtaining prior authorization from third party payers in order to maximize patients' access to treatment. Help support the appeal process to overturn insurance denials and/or benefit exclusions when needed. Works with Intake, Billing and Collection teams to resolve claims issues. Maintains confidentiality of all PHI in compliance with state and federal law. Other duties may be assigned. Education and Experience High School Diploma or equivalent Preferred: Meet state requirements of national certification (CPhT) or other board approved training program, if required by state. Previous Prior Authorization and Claims experience is preferred Knowledge, Skills, and Abilities Demonstrates a high degree of personal responsibility regarding accuracy and quality of work. Demonstrates ability to work effectively and maintain expected productivity. Ensures accuracy of information being provided to Management for review. Schedules own time based on priorities. Demonstrates Excellent customer service and Professionalism Ability to multi-task Ability to communicate effectively, patiently and courteously. Ability to work in a high pace, stress environment. Should be independent and self-motivated. Maintains a good attendance record. Work Environment / Physical Demands This position is in a typical office environment which requires prolonged sitting and standing in front of a computer. In addition, this position requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including the operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients and employees. This position may be required to work long hours. #J-18808-Ljbffr