Prior Authorization Specialist, Full Time

Job Description

Job Description

Cabinet Peaks Medical Center is seeking a team-oriented Prior Authorization Specialist to work in the Business Office!

Reporting to the Director of Revenue Cycle, this position is responsible for obtaining prior authorizations and pre-certifications for procedures and medications, coordinating the scheduling and re-scheduling with outpatient departments and patients.

Major Job Duties & Responsibilities

Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements.

Request, track and obtain prior authorization from insurance carriers within time allotted for medical and services.

Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.

Demonstrate and apply knowledge of medical terminology, high proficiency of general medical procedures including HIPAA regulations.

Works closely with other departments to gather the clinical information required by the payer to authorize services.

Maintains accurate records of authorizations within the EMR.

Identifies patients who will need to receive  Medicare Advance Beneficiary Notices of Noncoverage (ABNs) as well as other Commercial notices similar to the ABN.

Works with business office staff to support appeal efforts for authorization-related denials.

Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.

Maintains professional ton at all times when communicating with patients, payer representatives and fellow coworkers.

Performs other clerical duties assigned by Administration or Supervisor.

Adheres to the PROMISE standards and follows the AIDET practice.

Skills, Knowledge, & Abilities

Strong communications skills both verbal and written.

Professional Customer Services skills and pleasant and courteous demeanor.

Knowledge of insurances.

Ability to follow directions.

Ability to follow Federal/ State and hospital policy and guidelines.

Requires good judgement, tact, diplomacy, and ability to problem solve.

Requires effective customer relation skills both internal and external.

Strong organizational skills, including the ability to write and interpret notes.

Strong typing skills, and basic knowledge of office machines such as phones, faxes and copy machines.

Schedule

As per the needs of the department. 

Educational Requirements

High School Diploma or equivalent education.

Experience

Previous experience in medical setting preferred.

Benefits Package Available.

Full Time benefits package includes medical, dental, vision, long-term disability (LTD), and life & accidental death and dismemberment (AD&D) insurance for you and your eligible family members, plus a 403(b) retirement plan with employer match.

Cabinet Peaks Medical Center is committed to providing a safe, efficient, and productive work environment for all employees. To help ensure a safe and healthful working environment, each applicant to whom an offer of employment has been made will be required as a condition of employment to undergo a substance test. Additional pre-employment items may be required. Please contact Human Resources for details.