What are the responsibilities and job description for the Prior Authorization Specialist position at Auburn Memorial Medical Services?
Prior Authorization Specialist
General Position Description: The prior authorization specialist is responsible for coordinating all aspects of the prior authorization process including insurance verification, formulary reviews, gathering necessary clinical information from electronic medical record, and timely communication with patients, prescribers and physician office staff
Reporting: The Prior Authorization Specialist reports to the Practice Manager.
Duties and Responsibilities:
1. Interview patients to determine how they can be assisted in receiving authorizations for their medication and procedures
2. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
3. Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
4. Review accuracy and completeness of information requested and ensure that all supporting documents are present
5. Receive requests for pre-authorizations and ensure that they are properly and closely monitored
6. Consult with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity
7. Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
8. Manage correspondence with insurance companies, physicians, specialists and patients as required
9. Look through denials and arrange or submit appeals in an attempt to get them approved from insurance companies
10. Ensure documentation of pre-authorization and referral information is properly updated in EMR
11. Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation
12. Correspond with pharmacies as needed for prior-authorizations
13. Schedules patients for ancillary tests. Provides patient with appointment information and instruction as needed.
14. Correspond and coordinate with other providers involved in patient care for referrals and appointments
15. Completes all required training and continuing education as directed.
16. Train employees and perform other tasks assigned by the practice manager.
17. Initiate and complete insurance referral and prior authorizations.
18. Records and documents referrals in the patient’s chart as directed.
19. Maintain tidiness and cleanliness of work stations and patient waiting areas.
20. Attends mandatory staff meetings, morning huddles, training sessions and conferences.
21. Correspond and coordinate with other providers involved in patient care
22. EMR procedures
23. Provide excellent patient service.
24. Treats all patients, peers, providers and staff in a positive, professional manner.
25. Demonstrates efficient/productive use of work time. Arrives for work as scheduled and focuses on job duties as listed above. Punches in/out daily and for lunch as required in a timely fashion
Job Type: Full-time
Pay: $18.00 - $24.50 per hour
Benefits:
- 403(b) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Experience:
- Insurance verification: 1 year (Preferred)
- Medical billing: 1 year (Preferred)
Ability to Commute:
- Auburn, NY 13021 (Required)
Ability to Relocate:
- Auburn, NY 13021: Relocate before starting work (Required)
Work Location: In person
Salary : $18 - $25