Medical Prior Authorization Specialist
The Prior Authorization Specialist will ensure that insurance benefits are verified, patient responsibility amounts are calculated, and authorizations are obtained and procedures prior to the procedure.
??? Works with departments and insurance companies to obtain the necessary authorizations for services ordered.
??? Maintains a high level of understanding of insurance companies and billing authorization requirements.
??? Ensures insurance carrier documentation requirements are met and authorization documentation is scanned and documented in the patient???s CRM/Cognito record.
??? Communicates with other prior authorization specialists, Financial Services representatives and coders to continually monitor changes in the health insurance arena.
??? Appeal denials and/or set-up peer to peer reviews.
??? Maintains an approachable and appropriate attitude when interacting with all levels of personnel in a rapidly changing environment
??? Eagerness and ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects
??? Supports the vision and culture of the organization. Demonstrates personal commitment through active involvement in the performance improvement process.
??? Adheres to the Employee Handbook and Policies and Procedures
??? Collaborate with and teach other team members best practices for managing and submitting prior authorizations
??? Places calls to offices as needed to obtain, and to ensure timely process of patient chart flow
??? Discusses financial obligations with the patient or family member, explaining the fees and reimbursement process
??? Forwards all financial documentation to billing department.
This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as deemed necessary.
Working hours: 7 AM - 5 PM
- Associate's Degree or equivalent work experience
- Bachelor's Degree Preferred
??? Minimum years??? experience required 1-3 years
??? Education, training or experience as a medical coder, medical billing, Insurance Coordinator or other relevant clinical background preferred.
Required Skills, Knowledge, and Abilities
??? Knowledge of CPT, HCPCS and knowledge of ICD-10
??? Familiarity with Medical Terminology preferred
??? Proven customer service skills
??? Able to work in a high volume/fast-paced environment
??? Ability to work with sensitive and confidential information
??? Operating knowledge of personal computers and MS Windows applications (including Word, Excel and Outlook)
??? Capable of a flexible work schedule, including overtime hours as needed
??? Must be able to interact with patients, insurers and FS team members in a responsible, professional and ethical manner
??? Must be able to function effectively in a team-oriented environment
??? Must be able to work independently with limited direction
??? Must be reliable and demonstrate sound judgment and initiative
??? Possess a high degree of accuracy in work output
??? Ability to self-motivate
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