Prior Authorization Specialist - Medical Insurance

This large and growing medical organization is an integrated group practice comprised of a team of highly skilled medical doctors. As part of their dedication to complete care, their board-certified physicians and professional staff effectively evaluate, diagnose and treat acute and chronic conditions and diseases. With locations throughout four counties in northern New Jersey, their multidisciplinary practice offers coordinated and comprehensive services with an emphasis on personalized care for patients of all ages and activity levels. In addition, this practice is affiliated with five ambulatory surgery centers where their advanced procedures are performed in a warm, comfortable environment on an outpatient basis. This group has also announced that they now offer telemedicine visits as well!! Medical Insurance Prior-Authorization Specialist Responsibilities & Requirements Obtain pre-authorizations for gastroenterology procedures, medications, and infusions as well as: colonoscopy, endoscopy, ERCP, capsules, etc. Must have a strong understanding of CPT and ICD codes. Must have comprehensive knowledge of insurance carrier policies and procedures – insurance will often provide incorrect/misinformation (such as no authorization required). The Pre-Authorization Specialist must have the knowledge to be able to push back and question what they're being told by the insurance carriers. Responsible for handling Eligibility Verifications for all patients being seen each day using various portals – such as, our EMR (ECW), Navinet, Availity, E-tactics, etc. Since we are a busy and fast-paced practice, the Pre-Authorization Specialist will need to be experienced operating effectively in high volume situations to be successful in keeping up with the eligibility and authorization requests. MUST have experience and ability to comprehend and explain patient benefits. Such as deductibles, coinsurance, copays, any patient responsibility. In a professional manner. Experience calling patients to explain these benefits prior to their procedures. This requires customer service skills and the ability to explain and answer questions regarding patient benefits, as well as their financial responsibility. MUST possess the ability to effectively communicate with insurance providers, staff, and patients - both written and oral. The P.A. Specialist will regularly, on a day to day, be sending many emails to insurance providers and company staff regarding authorization requests and communicating with our patients regularly. You will be a representative to both our physicians and patients and must have the ability and experience to present yourself in a professional manner at all times. #J-18808-Ljbffr