GENERAL DESCRIPTION

The Prior Authorization Specialist I is responsible for diagnostic and procedure orders management, including completing prior authorizations, scheduling appointments, obtaining order results, and submitting results to the ordering provider. The Prior Authorization Specialists I assists patients with applications for programs to support the financial obligations needed to complete screening exams, and scheduling in-house diagnostic exams. Requirements

ESSENTIAL DUTIES

Reviews order within the Electronic Health Record System with insurance companies to determine need for prior authorization. Processes prior authorizations and sends any supporting documentation to insurance companies to expedite the prior authorization process. Schedules diagnostic imaging and procedure appointments appropriate for the patient's needs, internally or externally. Manage correspondence with insurance companies, physicians, specialist and patients, as needed, including documenting in the EHR as appropriate. Reviews denials and follows up with the provider to obtain medically necessary information to submit an appeal of the denial. Prioritizes orders by level of urgency. Requests order results from external facilities and submits the results to the order provider to support continuation of care. Assists patients with program applications to finance screening diagnostic imaging exams. To view full details and how to apply, please login or create a Job Seeker account