The Prior Authorization Specialist is responsible for all aspects of the prior authorization and precertification process.
Responsibilities include collecting all necessary documentation required for prior authorization for procedures, testing, and medications. Complete timely and accurate identification, submission, and follow up of prior and retro authorization requests to payors. Identify prior authorization trends and/or issues resulting in delayed treatment or claims processing. This position will initially be primarily in-person, with the opportunity to transition to a remote work arrangement overtime, based on business needs and role proficiency.
Essential Job Functions
Contact insurance carriers to verify patient's insurance eligibility, benefits, and requirements
Reviews documentation to ensure all medical policy guidelines are met
Request, follow up, and secure prior authorizations prior to services being performed including appeals if necessary
Communicates with patients to discuss prior authorization status
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
Communicate any insurance changes or trends among team
Maintains a level of productivity suitable for the department
Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
Other duties as assigned
Job Knowledge/Skills/Abilities
Previous prior authorization experience preferred
Excellent verbal and written communication skills
Effective customer relation skills
Must be highly organized
Physical Demands:
Independently mobile to perform tasks
Ability to be seated for up to 8 hours per shift
Ability to push, pull, or lift up to 60 pounds
High school Diploma or GED
Previous experience within a clinical setting and/or with health insurance carriers