Job Description
Position Title: Prior Authorization Specialist Supervisor: Prior Authorization Manager FLSA Status: Non-Exempt Mission To provide our patients and community the most innovative and breakthrough treatment options to improve overall health and wellness.
Values Innovation
Integrity
Patient Experience
Teamwork
Job Summary - Manages and processes Prior Authorizations including, but not limited to, Medicare, Commercial, Medicaid, and Worker’s Compensation for injections, procedures, and other prior authorization needs.
- Identifies insurance coverage and coordinates with patients on their pre-procedure requirements.
- Expert on insurance prior authorization requirements, policies, and guidelines.
- Effectively communicates with insurance companies, physicians’ offices, outside vendors, and patients.
- Resource for providers in determining patient authorization needs.
- Manages and processes authorization denials and appeals.
- Processes prior authorization paperwork.
- Facilitates prior authorization projects and tracking metrics as required.
- Cross-trains on other duties as required.
Supervisory Responsibility - This position has no supervisory responsibilities.
Qualifications - High School Diploma or GED required.
- Associate’s or Bachelor’s degree preferred.
- Minimum of 1-year of prior authorization experience required in healthcare environment.
- Medical terminology preferred (CPT/HCPCS, ICD-10 Codes, Procedures, etc.)
- NextGen experience preferred.
Skills & Abilities - Detailed oriented with ability to manage multiple priorities and work in a highly active environment.
- Strong verbal and written communication skills.
- Strong knowledge of insurance and eligibility.
- Ability to problem solve.
- Proficient computer and business skills.
- Self-directed, reliable, consistent.
- Ability to multi-task.
- Ability to work independently and with a team.
- Ability to be a professional representative of the company.
- Ability to follow directives as presented by your supervisor.
- Ability to follow company policies and procedures.
- Ability to abide by all HIPAA privacy laws.
Work Environment While performing the duties of this job, the employee regularly works in an office setting.
This is not a remote position. Physical Demands The Physical Demands Described Here Are Representative Of Those That Must Be Met By An Employee To Successfully Perform The Essential Functions Of This Job
While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to grasp or handle objects, tools, or controls; reach with hands and arms; stoop, kneel, or crouch; talk or hear. The employee must be able to sit for 90% of the day and occasionally lift or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
Compensation & Work Schedule - Full-time: 40 hours/week.
- Non-Exempt.
- Day Shift: Monday-Friday 8:00AM-4:30PM.
- No evenings or weekends.
- A competitive benefits package including health, life and dental insurance, 401K, PTO time, paid holidays and HSA plan is offered.
No Phone Calls, Please! JOB CODE: 1000140
Job Tags
Holiday work, Full time, Weekend work, Day shift, Afternoon shift, Monday to Friday,