Pre-Authorization Specialist

Job Title

Responsible for pre-authorization coordination on behalf of patients. This position will work as an advocate for patients by confirming and obtaining insurance authorization prior to certain medical services and treatments being provided.

Essential Job Functions

• Contact insurance carriers to verify patient's insurance eligibility, benefits, and requirements.
• Request, track, and obtain pre-authorization from insurance carriers dependent on priority status given for medical and pharmaceutical services. Request follow-up and secure prior authorization prior to services being performed.
• Work in collaboration with the medical and pharmacy staff to obtain any additional clinical documentation and communicate with appropriate insurance carrier.
• Communicate any insurance changes or trends to leadership and recommend new and changes to processes and workflows as needed.
• Clearly document all communication and prior authorization documentation, in standardized documentation requirements, and save in Electronic Health Record (EHR) as appropriate.
• Communicate the approval or denial of the procedure/infusion to the patient and the provider team.
• Professionally respond to all telephone calls, emails, internal messages, EHR requests in a timely manner to ensure patients' needs are met prior treatment.
• Communicate directly with patients to explain outcome of request and any monetary requirement they may be held responsible to. Schedule patient for specified medical or pharmaceutical service.
• Work hours to mirror standard insurance carrier hours (Monday Friday, 8am 5pm).

Knowledge, Skills & Abilities

• Knowledge of healthcare pre-authorization procedures and insurance claims processing.
• Skill in using a computer and a variety of software, including Electronics Health Records (EHR) software, scheduling software, Word, Excel, Access, and Outlook.
• Skill in communicating in a professional manner, both verbally and in writing.
• Skill in managing multiple priorities and delegating as needed.
• Ability to be a good representative of the Company.
• Ability to maintain confidentiality regarding sensitive issues, patient care, privacy, and confidentiality.

Education & Experience

High School diploma or GED required. Minimum of two (2) years of experience working with Pre-Authorization and/or medical insurance, clinical setting ideal.

Working Conditions and Physical Effort

This role operates in a healthcare setting. This position requires frequent sitting and computer work and allows employee to vary physical position or activity for comfort.

• Stand 5% or longer of workday.
• Walk 10% or longer of workday workday.
• Sit 85% or longer of workday workday.
• Requires employee to: Bend, squat, kneel and reach above shoulder level occasionally.
• Requires repetitive use of hands for: Simple grasping, fine manipulation, computer use
• Requires all sensory skills (speech, vision, smell, touch, and hearing) corrected to near normal range.

Note: The information above is a reflection of the general nature of job duties. From time to time, additional duties may be assigned.

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