What are the responsibilities and job description for the Medical Management Outpatient Pre-Auth Specialist position at Blue Cross Blue Shield of Louisiana?
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSE
The Medical Management Outpatient Pre-Auth Specialist provides administrative support throughout Blue Cross Blue Shield of Louisiana’s authorization process. This includes answering phone calls to Medical Management, entering specific types of authorizations, performing call-backs for approvals and providing other types of non-clinical support to the Medical Management Department.
NATURE AND SCOPE
- This role does not manage people
- This role reports to these jobs: Supervisor of Medical Management Outpatient RN, Medical Management Outpatient RN Coordinator, and the occasional supervision of the Director of Medical Management
QUALIFICATIONS
Education
- High School Graduate
Work Experience
- Must have 1 year experience in a healthcare office setting
- Must have 2 years’ experience in business office setting
Skills and Abilities
- Medical Terminology knowledge preferred
- Exceptional organization skills required
- Must possess proven abilities to prioritize and multitask
- Ability to work with supervision and follow established policies and procedures
- Exceptional interpersonal, verbal, and written communication skills
- Customer service-oriented attitude/behavior
- Excellent computer skills, including intricate knowledge of Microsoft Office programs including Excel, Outlook and Word
- Experience in the following preferred: Acuity, QNXT, Vnet, Faxcom
Licenses and Certifications
- None required.
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
- Answers incoming phone calls regarding authorization verifications and provides notification of authorization approvals, as indicated
- Provides guidance for non-clinical questions regarding authorizations, such as where to locate the preauthorization form on BCBSLA’s website and assists with provider requests for emailing or faxing the preauthorization form
- Assists with the collection and data entry for pre-authorizations under the supervision of appropriately licensed health professionals. This may include demographic information (e.g. patient’s name, date of birth, ordering physician, where services are to be performed, date of service, etc.) Clinical information recorded will be limited to the diagnosis and name of the requested service or procedure
- Approves services based on set criteria where no clinical judgment is required.
- Completes auto-approved Acuity Connect authorizations and adjusts as necessary
- Provides assistance to members and providers regarding Your Hearing Network program. This includes verifying benefits.
- Prepare and mail out Medical Management member surveys on a quarterly basis
- Additional duties as assigned
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
- Perform other job-related duties as assigned, within your scope of responsibilities.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
- The ability to comprehend, document, calculate, visualize, and analyze are required.
- Occasional travel required
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An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance
