Prior Authorization Specialist

Position Title: Prior Authorization Specialist Work Location: Houston, TX 77056 (Hybrid) Assignment Duration: 3 Months (contract-to-hire) Hybrid Remote: Enjoy the flexibility of working from home and collaborating three days a week at our office in Houston, Texas Description :Accurately complete all fields in the patient demographic and insurance screens within the computer system

• Call the patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions
• Attempt to obtain and document in the computer system referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation
• Obtain and document in the computer system the precertification/preauthorization number from insurance companies prior to each surgical procedure and diagnostic test
• Assist patients with scheduling new patient office visits with CVCP provider offices
• Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants
• Complete all fields within the computer system necessary to process claims and re-route claims to the billing department per assigned deadline
• Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute the list to precertification staff for processing
• Correct any account in which errors have occurred per the assigned deadline
• Maintain constant communication among the physician, insurance company, and CVCP regarding authorization and the CVCP authorization status on patients
• Maintain a minimum average of 30 CVCP authorizations per day with proven accuracy after 3 months

Required Experience / Qualifications nsMinimum 2 years of experience in working in precertificati onWorking knowledge of managed care in all areas, most notably: referrals, insurance verification, and precertificatio n.Knowledge of medical terminolo gyFamiliarity with ICD-9 and ICD- 10Strong analytical skills with the ability to assess and analyze trends to determine the most effective approach to bi llDetail-oriented and strong critical thinking skills for solving problems on your o wnAbility to perform multiple tasks simultaneously and problem solve efficient lyExcellent organizational and interpersonal skil lsStrong desire to learn and utilize technology effective lySome experience with Microsoft Office including Tea msQuickly able to enter data accurately and understand the information enter edFlexibility to work overtime occasionally, typically when onboarding new clien At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. #J-18808-Ljbffr SPECTRAFORCE