Prior Authorization Specialist
Axelon
Summary:
- Responsible for screening and processing prior authorization requests in the medical care management program.
- Adheres to policies and procedures to comply with performance and compliance standards and ensure cost-effective and appropriate healthcare delivery.
- Work Mode: Remote
- Prioritizes incoming prior authorization requests received from faxes and the provider portal.
- Processes incoming requests, including authorizing specified services, as outlined in departmental policies, procedures, and workflow guidelines.
- Requests clinical information and outreaches to providers for missing information.
- Refers authorization requests that require clinical judgment to Prior Authorization Clinician, Supervisor, or Medical Director.
- Meets or exceeds position quality, quantity, and data metrics and turnaround timeframes.
- Supports Prior Authorization Clinicians.
- Answers ACD line calls, verifies member eligibility, and enters information necessary to document the caller's request in Jiva.
- Identifies and informs callers of network providers, services, and available member benefits.
- Engages in professional communications, following department protocols for opening and closing the call and leaving messages.
- Informs provider of decision per department procedure.
- Coordinates resolution of escalated member or provider inquiries as related to prior authorization.
- Works with providers and key departments to promote an understanding of prior authorization requirements and processes.
- Participates in team operational activities, including handling primary responsibilities for triage function and department voicemail coverage.
- Meets organizational standards for assuring member and provider communications are accurately sent to appropriate recipients.
- Other duties as assigned.
- Associate's degree in healthcare, social work, or related area, or the equivalent combination of training and experience is required.
- Ability to prioritize and manage multiple tasks in a fast-paced environment within turnaround timeframes.
- Ability to process a high volume of requests and meet performance targets with a 95% or greater accuracy rate.
- Sense of urgency.
- Strong customer service skills.
- Effective collaboration skills that work well in a team setting.
- Strong listening, oral, and written communication skills.
- A strong working knowledge of Microsoft Office products.
- Bachelor's Degree.
- Three or more years of experience in a medical practice administrative position.
- Experience with Jiva, FACETS, or other healthcare databases.
- Experience with Health Plan Utilization and Customer Service.
Vacancy posted 3 days ago
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