Prior Authorization Specialist

Authorization Specialists help our practice to be successful by excelling at obtaining insurance authorizations for procedures. This entails having a strong background in obtaining authorizations, understanding and have the ability to navigate through the challenging environment of healthcare insurance verification and approvals, as well as ultimately scheduling the patient for the procedure. Excellent customer service skills are necessary to serve the needs of the payer, the provider and the patient.

What You'll Do:

Resolves pre-certification, registration and case-related concerns prior to a patient's appointment. Ensures patients have been cleared for specialty service office visits. Obtains referrals from primary care physicians. Verify eligibility and benefits to establish office visit. Work on daily list for designated physician(s) and follow up with office via fax to determine patient coverage, coordination of benefits, etc. Do pre-certification for surgical procedures (call insurance company to verify if deductible met, fax clinical to insurance company pre-certification department to obtain authorization for procedure). Respond to phone calls from internal doctor teams, check in/check out staff, or primary care physician offices and respond accordingly. Relays pertinent messages from hospitals and directs team to reschedule surgical procedures at facility where benefits are accepted. Assist billing department to obtain retro referrals for services that were rendered (either office visits or surgical procedures). This may include hospital procedures, office visits or outpatient surgical procedures. Review daily schedules to verify that visits have been through pre-authorization process. Any new additions to the schedule will require coordination of benefits and follow up with the respective department. Review personal faxes for newly scheduled surgery and conduct insurance verification and obtain proper authorizations. Daily review of internal practice management system for requests from doctor's team offices. This may include rescheduled surgeries, rescheduled office visits, etc. May explain benefits information to patients who arrive to visit and may not understand their portion of the bill (co-pay, deductibles, etc.). Data enter pre-authorization deductibles, co-insurance, out-of-pocket and related information in to patient demographic record.

What You'll Need:

Must have a High School Diploma or equivalent. Knowledge of health insurance concepts (i.e., HMO, PPO, etc.). Experience in a healthcare environment a plus. Proficient computer skills. Exceptional customer service skills. Proficient and accurate data entry skills. Ability to multi-task, prioritize work and make sound judgments. Ability to remain patient during long periods of telephonic hold times. Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company. Prolonged sitting. Repetitive motion (data entry), and phone contact. Movement between locations to support the pre-authorization process.

What We'll Do:

All new employees are hired as contract employees. It gives both of us the opportunity to determine if this is the best job fit. Once the evaluation period is successfully passed, then the employee will be offered a full time position with the benefits described.

Job Type:

Full-time Pay:

From $17.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person