Prior Authorization Specialist - 20 / hour

Prior Authorization Specialist

• Review information obtained from scheduler for completeness and obtain missing information
• Review available patient information to obtain patient insurance information
• Review practice information to determine if prior authorization is required
• When prior authorization is required or it is unclear from internal documentation if it is required, contact insurance to obtain authorization
• Provide insurance company with any required documentation to obtain the authorization
• Follow up on outstanding requests to ensure all required authorizations are required
• Maintain detailed documentation on prior authorization activities in EHR including :
• Documentation of why authorization is not required if not obtained
• Details of all calls to insurance companies including the name of the insurance contact, date and time of call, reference number, summary of call outcome
• Details of information sent to the insurance company including how the information was sent, date sent, and information included
• Authorization number for the procedure, date obtained, and method for obtaining (website, insurance rep, other)
• Maintain ongoing communication with schedulers regarding status of the prior authorization (pending, approved, not approved, not required)
• If required, set up peer to peer review and provide required information
• On a daily basis, review and prioritize requests for prior authorization to ensure prior authorizations are obtained in a timely and efficient manner
• Update practice information on prior authorization requirements as changes are identified
• Coordinate with Billing on claims denied for lack of prior authorization to provide information to support appeals process
• Assist with surgery scheduling activities if requested
• Attend regular on-site meetings for process collaboration or review the status of ongoing prior authorization requests.
• Attend regular on-site meetings to provide information to support appeals process.
• Generate reporting related to the success rate of prior authorizations, the number of appeals submitted, and other key metrics. These reports will be shared with managers or the healthcare organization to improve efficiency and identify areas for improvement.
• The coordinator works closely with doctors, nurses, and other medical professionals to gather the correct medical documentation for the prior authorization. This may require in-person collaboration with other departments.
• Adhere to policies of organization OSHA, and HIPAA standards and guidelines.
• Perform strategic and tactical functions to do whatever is required to model outstanding customer service toward our patients, clients and staff.
• Perform other duties as assigned.

Beacon Hill is an equal opportunity employer and individuals with disabilities and / or protected veterans are encouraged to apply.

California residents : Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

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Company Profile :

Founded by industry leaders to set a new standard in search, career placement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, a commitment to project completion and success and a passion for innovation, creativity and continuous improvement.

Our niche brands offer a complete suite of staffing services to emerging growth companies and the Fortune 500 across market sectors, career specialties / disciplines and industries. Over time, office locations, specialty practice areas and service offerings will be added to address ever changing constituent needs.

Learn more about Beacon Hill and our specialty divisions, Beacon Hill Associates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal, Beacon Hill Life Sciences and Beacon Hill Technologies by visiting

www.bhsg.com

Benefits Information :

Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings.

We look forward to working with you.

Beacon Hill. Employing the Future (TM)