What are the responsibilities and job description for the Authorization Specialist position at Christian Community Health Center?
Job Title:
Prior Authorization Specialist
Prior Authorization Specialist
Employment Status
Exempt
Minimal Qualifications/Experience/Skills
Minimum of High School Diploma and at least Five years of experience in community health care field. An ideal candidate will have prior experience and understanding of medical terminology, understanding of various insurance plans and their coverage details. Prior Authorization Specialists have in-depth proficiency in coding using CPT and ICD-10 is necessary, particularly for areas like pain management, orthopedics, radiology, and chiropractic services. Strong clear and effective communication, customer service and computer skills are also imperative. Moreover, possessing keen attention to detail and exceptional organizational skills is vital for managing deadlines effectively. The individual should possess good interaction skills and be proactive, self-sufficient, efficient, and resourceful. Strong decision-making ability and attention to detail are equally important. Proficient computer skills and in-depth knowledge of relevant software such as MS Office Suite. Excellent verbal and written communication skills. Demonstrate the skill set to gather and monitor a plethora of highly sensitive information. Must display problem-analysis analysis problem-solving skills. Will review highly sensitive information and must demonstrate the ability to maintain confidentiality.
Summary
Perform prior authorization responsibilities, which entail determining if the insurance company even covers a given procedure or service. works to obtain approval from insurance companies on behalf of healthcare providers.
Responsibilities
- Verifying patient information: Confirming patient insurance coverage and benefits, and identifying patient information
- Processed inbound prior authorization requests via phone and fax.
- Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.
- Responsible for preparing and submitting detailed authorization requests to insurance companies, complete with all necessary documentation.
- Investigating benefit information: Determining patient payer authorization requirements and confirming if an authorization is required
- Obtaining authorization: Contacting insurance companies to obtain authorization as needed
- Updating patient information in the computer system and records to prevent billing issues
- Completing authorizations and referrals for services, including appointments and procedures
- Reviewing medical history: Reviewing patient's medical history and insurance coverage for approval
- Communicating with physicians: Contacting referring physicians for additional information as needed
- Keep track of authorization requests, follow up with insurance companies, and keep detailed records of all communications.
- Monitoring schedules: Monitoring schedules for potential issues
- Completing billing documentation: Completing billing documentation and performing all insurance related assignments as instructed.
