Prior Authorization Specialist

Department

12856 Wake Forest Baptist Medical Center - VP: Clinical Operations

Status

Full time

Benefits Eligible

Yes

Hours Per Week

Schedule Details/Additional Information

Monday-Friday, 8 hour days

Pay Range

$22.90 - $34.35

Job Summary: The incumbent for this position is responsible for doing follow-up for the SCORE Prior Authorization team. This position will be responsible for calling third-party insurance companies to check prior authorization status, checking third-party payor portal for prior authorization status, handling facsimiles related to prior authorization status, and scan correspondence into the patient's electronic medical record.

Education/Experience

• High school and two years' experience in third party payers, healthcare administrative support or general clerical experience.
• Authorization process experience preferred.
• Associate or bachelor's degree preferred.

Essential Functions

• Expedites sorting of surgical cases and checks status of prior authorization with shortest lead times.
• Documents prior authorization activities appropriately and communicates necessary information to SCORE Prior Authorization team.
• Evaluates processes, problem solving, and participates in departmental continuous improvement programs to enhance workflow processes and patient-centered outcomes.
• Maintains a working knowledge of computer systems supported by the department.
• Prioritizes and organizes daily work to ensure completion on time.
• Maintains professional development.
• Assists management in developing training materials.
• Performs other duties as assigned.

Skills/Qualifications

• Strong oral and written communication skills
• Ability to exercise independent judgment in unusual or stressful situations
• Strong computer skills
• Ability to establish and maintain effective working relationships

Work Environment

• This is a virtual and in-office position.
• Subject to many interruptions
• Operates keyboard, photocopier, telephone, and other office equipment
• Work may be stressful at times
• Occasionally subject to irregular hours

Our Commitment To You

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits And More

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

The incumbent for this position is responsible for doing follow-up for the SCORE Prior Authorization team. This position will be responsible for calling third-party insurance companies to check prior authorization status, checking third-party payor portal for prior authorization status, handling facsimiles related to prior authorization status, and scan correspondence into the patient's electronic medical record.