A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Blue Ridge Health is currently seeking a Prior Authorization Specialist to be part of our Medical team in Hendersonville, NC.
What We Offer You:
A competitive benefits plan, including Medical, Dental and Vision Company sponsored life insurance and short and long-term disability coverage 403(b) retirement account with company matching Supplemental accident insurance available 9 paid holidays per year PTO and Personal Day accrual, starting day 1 - (We value a work-life balance!)
Flexible Schedules Available What You'll Do:
The Prior Authorization Specialist collaborates with patients, internal staff, other medical center representatives, and third-party payers to facilitate the smooth exchange of information related to obtaining timely prior authorizations for pharmaceutical and imaging patient needs.
Responsibilities include:
Applies clinical and pharmaceutical criteria for processing prior authorization requests in a timely manner for pharmacy needs. Reviews notifications of patient prescription rejections via covermymeds.com, faxed document scanned directly to the desktop, or patient notification Reviews received Medicaid prescription rejections in NCTracks Applies clinical and pharmaceutical criteria for processing prior authorization requests in a timely manner for imaging needs. Processes appeals and redeterminations as needed Assists in provider training or updates on efficiencies related to the prescription or imaging process prior authorization process. Communicates with appropriate parties in a timely and effective manner for completion of prior authorizations.
What We're Looking For:
High School Diploma or equivalent, required Current North Carolina Pharmacy Technician, required Strong knowledge of pharmacy terminology Experience working in an interdisciplinary and/or integrative health care model Proficiency in MS Office programs required. Familiarity with Electronic Health Records (EHR) and other databases, preferred. Proficiency in Spanish, preferred.
About Blue Ridge Health:
At Blue Ridge Health our mission is to improve Health, inspire Hope, and advance Healing through access to Compassionate, Affordable, and Quality Care. We are seeking individuals with a passion for creating an exceptional patient and client care experience to join our team! We are a nonprofit system of Federally Qualified Health Centers (FQHCs) that works closely with communities to meet the ever-changing medical and behavioral healthcare needs of individuals throughout WNC. We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
