Prior Authorization Specialist

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!

Strategic Staffing Solutions is currently looking for Prior Authorization Specialists for a contract opportunity with one of our largest clients located in Detroit, MI!

Title: Prior Authorization Specialists – multiple openings
Location: Detroit, MI
Duration: 12+ Months
Role Type: W2 contract engagement

ROLE SUMMARY

Medicare Advantage Post-Acute Care Specialist:

• Support healthcare providers and UM reviewers with prior authorization requests for post-acute care services.
• Includes manually entering authorization requests into healthcare system, following rules and algorithms embedded in the care management system to administratively approve prior authorization requests.
• May work with providers to secure discharge plans, Notice of Non-Medical Coverage, Durable medical equipment, and other home supports required for discharge planning.
• May support scheduling physician to physician calls.
• Will support appeal processes for CMS designated Quality Improvement Organization appeals including logging all appeal activities.
Requirements:

• High School Graduate or GED equivalent required.
• Two (2) years of college preferred.
• Two (2) years’ experience as medical assistant, care technician, post-acute care and home health care support staff or ancillary services in other health care related field preferred.
• Knowledge of post-acute care functions and processes or discharge readiness activities may be preferred for some positions.