Prior Authorization Specialist

Position Title: Prior Authorization Specialist

Work Location: Houston, TX 77056 (Hybrid)

Assignment Duration: 3 Months (contract-to-hire)

Hybrid Remote: Enjoy the flexibility of working from home and collaborating three days a week at our office in Houston, Texas

Description

• :Accurately complete all fields in the patient demographic and insurance screens within the computer system
• .Call the patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions
• .Attempt to obtain and document in the computer system referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation
• .Obtain and document in the computer system the precertification/preauthorization number from insurance companies prior to each surgical procedure and diagnostic test
• .Assist patients with scheduling new patient office visits with CVCP provider offices
• .Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants
• .Complete all fields within the computer system necessary to process claims and re-route claims to the billing department per assigned deadline
• .Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute the list to precertification staff for processing
• .Correct any account in which errors have occurred per the assigned deadline
• .Maintain constant communication among the physician, insurance company, and CVCP regarding authorization and the CVCP authorization status on patients
• .Maintain a minimum average of 30 CVCP authorizations per day with proven accuracy after 3 months

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Required Experience / Qualificatio

• nsMinimum 2 years of experience in working in precertificati
• onWorking knowledge of managed care in all areas, most notably: referrals, insurance verification, and precertificatio
• n.Knowledge of medical terminolo
• gyFamiliarity with ICD-9 and ICD-
• 10Strong analytical skills with the ability to assess and analyze trends to determine the most effective approach to bi
• llDetail-oriented and strong critical thinking skills for solving problems on your o
• wnAbility to perform multiple tasks simultaneously and problem solve efficient
• lyExcellent organizational and interpersonal skil
• lsStrong desire to learn and utilize technology effective
• lySome experience with Microsoft Office including Tea
• msQuickly able to enter data accurately and understand the information enter
• edFlexibility to work overtime occasionally, typically when onboarding new clien

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Applicant Notices & Discla

• imersFor information on benefits, equal opportunity employment, and location-specific applicant notices, c lick

here
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local