Prior Authorization Specialist

Job Description

Job Description

Description

Utilizing billing, clinical resources, and customer service skills to effectively and efficiently triage for prior authorization requirements as needed for coverage.  Performs day to day Insurance Verification and Prior Authorization activities to support the Revenue Cycle and to ensure reimbursement for services in a timely and accurate manner.

Schedule
Monday - Friday 8 am - 5 pm

The identification of Duties and Responsibilities does not display an exhaustive list of all duties that may be assigned to this position, nor does it restrict the related work that may be assigned to this position.

• Review insurance requirements to determine if prior authorization is required.
• Utilizes resources to identify any testing that may require prior authorization.
• Review chart documentation to ensure patients meets payers medical necessity policy guidelines.
• Review requisition to determine billing information, including insurance carrier and complete/submit accurate documents as required.
• Coordinate with client to obtain needed medical documentation.
• Ability to accurately complete the necessary paperwork to submit prior authorization request to insurance via phone, website, software, or fax
• Timely follow-up with insurance carriers on pending prior authorization requests
• Timely notification of appropriate RCM department of prior authorization status
• Maintains current knowledge of payer policies and requirements and acts as a resource to team members and patients.
• Maintain HIPAA Compliance

What will make you awesome:

• Ability to review patient chart to ensure completeness and accuracy of information.
• To be well-organized with a strong attention to detail is essential.
• Ability to work efficiency and effectively under tight deadlines and high work volume
• Advance knowledge of medical billing and coding
• Ability to assist consistently with patient and physician request and act as a resource regarding insurance and authorization requirements. 
• Excellent problem-solving skills.

What you know:

• Possess at least one year of experience in a clinical setting
• Knowledge of medical billing and coding.
• High school graduate or equivalent
• Ability to work as a team member as well as independently.
• Strong interpersonal and communication skills.

• Competitive wages
• Robust benefit package including medical, dental, life and disability (short- and long-term) insurance
• Generous paid time off (PTO) program
• Seven (7) company paid holidays
• 401(k) retirement plan with company match
• An organization focused on People, Passion, Purpose and Progress
• Inspirational culture