Clinic Prior Authorization Specialist

• Performs telephonic or on-line prior authorization requests for outpatient services ordered by our providers as indicated.

• Maintain records of all prior authorizations obtained and document in the electronic medical record.

• Monitor trends for prior authorizations and communicate these with Department Managers.

• Appropriately prioritize workload to ensure that the most urgent cases are handled in a timely manner.

• Ensures timely and accurate insurance authorizations are in place prior to services being rendered.

• Communicates regularly with other departments regarding status of prior authorizations.

• Becomes proficient in the use ofICD-10 and CPT codes.

• Notify patient of the status and patient responsibility for the requested service after the prior authorization is completed.

• Council patient with finance for billing/payment arrangements.

• Maintain a professional environment.

• Perform all duties with legal limitations as properly authorized, delegated or assigned.

• Uphold confidentiality and HIPAA compliance at all times.

Develop and maintain working relationships with external agencies and providers who provide services at Scott County Hospital.

Authorize outpatient appointments and procedures through Workman's Compensation and auto insurance, as necessary.

Validate VA authorization 72 hour for the E.R. Other duties may be assigned.

The preceding/unctions /,ave been provided as examples oftl1e types of work performed by employees assigned in this job classification. Management reserves the right to add, modify, change or rescind work assignments and to make reasonable accommodations as needed. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skills. and /or abilities required. Reasonable accommodations may he made to enable individuals with disabilities to perform the essential functions.

• High school graduate with computer experience and or keyboarding skills. 
• Related office experience may be substituted for one to two months on-the-job training. 
• Three to six months on-the-job training may be provided to become familiar with clinic and hospital record keeping system and to comprehend pertinent medical terminology. 
•  Word processing applications/Excel
• Verbal ability is required to read and understand medical terminology, understand written reports, and to abstract pertinent information from records.
• Ability to communicate via telephone, translate to written form accurately.

 Additional Requirements:

Initiative, tolerance, adaptability, motivated, positive regard for others, objectivity, self-assessment, analytical, flexible, able to interrelate with others, willing to. learn, assumes responsibility, does not wait to be told what to do and how to do it, inquisitive, accepts individual challenges, adaptability, listens effectively, gives clear directions, good judgment and decision-making skills, analytical thinking, ability to summarize, probe and clarify. Ability to manage personnel effectively.