Prior Authorization Specialist - FT (40hrs / week) - Day Shift

Job Description

Job Description

Description : Job Summary

Oversees the process of incoming patient orders and obtains information necessary to complete the pre-authorization and scheduling of an order. This process includes collecting all the necessary documentation, contacting the referring provider if needed. This position will also be responsible for the completion of the required pre-authorization process for obtaining insurance and Medicare / Medicaid payment approval prior to the scheduling of an order.

Duties and Responsibilities

• Maintains process for identifying and prioritizing orders for scheduled services requiring pre-authorization.
• Reviews documentation from ordering physician to meet the needs of the payee.
• Verifies diagnosis code on patient billing is accurate and reimbursable / payable.
• Works with patients’ insurance companies to pre-certify / authorize services as ordered by the referring physician.
• Communicates with departments as needed to keep them updated.
• Communicates with customers to request additional documentation as needed.
• Utilizes EHR to document pre-authorization numbers and notes pertaining to acquiring pre-authorization.
• Assists with any denied claims to resolve any issues.
• Educates and assists departments in medical necessity determinations and collaborating with ordering physician offices for appropriate testing.
• Utilizes EHR in automated processes of determining medical necessity of services.
• Actively engage in quality improvement activities.
• Perform other duties as assigned.

Requirements : Minimum Requirements

Preferred Requirements

Skills / Competencies

Physical Requirements

Perceive the nature of sounds by the ear, express or exchange ideas by means of spoken word, perceive characteristics of objects through the eyes, extend arms and hands in any direction, seize, hold, grasp, turn, or otherwise work with hands, pick, pinch, or otherwise work with fingers, perceive such attributes of objects or materials as size, shape, temperature, or texture; and stoop, kneel crouch, and crawl. Must be able to lift 25 pounds maximum with frequent lifting, carrying pushing, and pulling of objects weighing up to 10 pounds. Continuous sitting, walking and standing. Must be able to identify, match, and distinguish colors.