Medical Prior Authorization Specialist

Medical Prior Authorization Specialist Desert Sky Spine & Sports Medicine - 3.3 Tucson, AZ Job Details Full-time From $18 an hour 1 day ago Benefits Health insurance Dental insurance Paid time off Vision insurance Qualifications Customer service HIPAA High school diploma or

GED ICD-10 CPT

coding Medical terminology Full Job Description Responsible for obtaining insurance pre-certification and prior authorization for visits & procedures. Provide exceptional customer service to our patients. Building and maintaining positive working relationships with referring provider offices and insurance companies.

Responsibilities:

Reviews upcoming provider schedules to ensure all appointments have appropriate referral and authorizations required for anticipated visits and procedures. Submits prior authorizations according to payer requirements (Phone/Fax/Web). Ensures all pertinent medical documentation is accurate and present prior to authorization submission. Follows up with pending authorizations on a regular basis to obtain the current status or to be informed of any action needed in order to obtain the authorization approval. Communicates any authorization denials to the appropriate staff. Handles any discrepancies, errors, or omissions of authorization denials and files appeals when necessary for overturn of adverse decision. Exhibit and manage excellent turn-around time in order to ensure timely authorizations. Consistently work in a positive and cooperative manner with fellow team members. Demonstrate flexibility to perform duties wherever volume deems it necessary. Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner. Complies with applicable HIPAA regulations. Maintain patient confidentiality as defined by state, federal and company regulations Other job related duties as assigned.

Accountability:

Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to position. Attention to

Detail:

Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.

Collaboration/Teamwork:

Cooperates with others to accomplish common goals; works with employees within and across his/her department to achieve shared goals; treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.

Customer Focus:

Ensuring that the customer perspective is a driving force behind business decisions and activities; crafting and implementing service practices that meet customers' and own organization's needs.

Initiative:

Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.

Managing Work and Time/Project Management:

Effectively managing one's time and resources to ensure that work is completed efficiently. Effectively manages project(s) by appropriately focusing attention on the critical few priorities; effectively creates and executes against project timelines based on priorities and resource availability. Effectively evaluates planned approaches, determines feasibility, and makes adjustments when needed.

Peer Relationships:

Interacts with others in a constructive, positive, and respectful manner, regardless of individual differences. Assists team members or co-workers in achieving personal goals and completing assignments.

Attendance:

Accurately record arrival/departure times and hours worked. Consistently report to work on time and return from breaks promptly. Adhere to the established attendance policy. Contact supervisor appropriately when absent or tardy.

Appearance:

Maintain personal grooming and hygiene and set an example for the department. Conform to dress code for appropriate business attire to include conservative, modest styles, and moderation in makeup, perfume/cologne, jewelry, hairstyle and fingernails. Present professional image in dress, demeanor, and style of communication.

Required Qualifications:

High School Diploma or GED Equivalent Customer Service Medical Terminology Preferred Experience/Qualifications:

1 year Medical Office Insurance and Prior Authorization experience Knowledge of insurance carriers, insurance websites and authorization process Knowledge of CPT and ICD-10 codes Basic knowledge of pain management procedures

Physical Requirements and Working Conditions:

This is largely a sedentary role and during an 8-hour day will typically spend 85% or more sitting for continuous periods of time, viewing a PC monitor, and utilizing a computer keyboard.

Job Type:

Full-time Pay:

From $18.00 per hour

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person