What are the responsibilities and job description for the Prior Authorization Specialist position at Clay County Medical Center?
Prior Authorization Specialist - Full-time position with our Patient Accounting team at Clay County Medical Center. Responsible for monitoring schedules within CCMC to determine which patient services require prior authorization and obtain approval. In addition, assists with other duties as assigned. These activities are completed following established policies and procedures, and in compliance with payer contracts, HIPAA, regulatory agencies and the organization's Code of Conduct.
Essential Duties and Responsibilities : include the following.
- Receive request for prior authorizations through the electronic health record (EHR) and / or via phone or fax and ensure that they are worked in a timely manner.
- Process requests and submit medical records to insurance companies to expedite authorization process
- Manage correspondence with insurance companies, physicians, and specialist as needed, including documenting in the EHR as appropriate.
- Review accuracy and completeness of information requested and ensure that all supporting documents are present.
- Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
- Other duties as assigned.
Qualifications
Requirements :
Monday-Friday, day shift, 40 hours a week. Full benefit package including insurances, retirement, paid time off, and medical leave. $5,000 Sign-on bonus for a two year commitment in this position.
Post offer physical, drug screen, and background check required.
