Prior Authorization Representative

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribes and triages patient calls to physicians, and coordinates patient appointments/orders.

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribes and triages patient calls to physicians, and coordinates patient appointments/orders.

Essential Functions and Responsibilities:

• Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Request, follow up and secure prior authorizations prior to services being performed.
• 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.

Supervisory Responsibility:

• No direct reports

Working Conditions and Environmental/Physical Demands:

• Sedentary work that primarily involves sitting/standing.
• Moving about to accomplish tasks or moving from one worksite to another.
• Light work that includes moving objects up to 20 pounds.
• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands and/or fingers.
• No adverse environmental conditions expected.

Position/Type/ Expected Hours of Work:

• This is a full-time position and core hours of work and days are Monday through Friday 8:00 a.m. to 5:00 p.m.
• Potential for evening and weekend hours as required.

Travel:

No Travel is required

Qualifications:

• Minimum of 2 years of performing pre-authorization in a clinic or similar setting
• Medicaid, Medicare, and other third-party payor reimbursement guidelines and requirements
• Experience working with confidential medical information
• Experience in computer programs such as EMRs, Word, Excel

Skills and Abilities:

• Ability to navigate various websites and carrier portals
• Highly organized with developed time management skills
• Excellent customer service and telephone etiquette
• Excellent verbal and written communication skills
• Strong research and problem-solving skills; attentive to details
• Ability to operate a computer and general office machines
• Must be self-directed, able to work independently, as well as work in a team-oriented and fast paced environment
• Ability to clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.