What are the responsibilities and job description for the PRIOR AUTHORIZATION SPECIALIST position at Jefferson Regional Med Ctr?
Hours: Days
Education, Experience and Skills Requirements: High school diploma or equivalent. Minimum 2 years of experience with hospital insurance eligibility and verification. Must be able to communicate well and able to multi-task and have excellent time management skills. Strong knowledge on insurance plans, benefits, and prior authorization process. Ability to work independently and manage multiple tasks simultaneously Strong attention to detail and organization skills Ability to handle sensitive information with confidentiality and professionalism.
Education, Experience and Skills Preferred: Associate Degree in healthcare administration, medical billing/coding, or a related field. ICD10 and CPT coding experience preferred. Knowledge of medical terminology and experience with coverage guidelines for government and commercial payers preferred. Excellent communication and interpersonal skills preferred.
The Prior Authorization Specialist primarily focuses on insurance eligibility and verification, obtaining prior authorizations, and checking medical necessity. This position works closely with physician offices and scheduling team. They will deal with a diverse group of physicians, patients, clinics and payers.
Essential Duties and Responsibilities: Maintain accounts assigned through processes and keep at a low capacity Learns from errors and exercises change development in workflow Informs clinics of errors and implements workflow change timely Verifies eligibility, obtain authorizations and verify medical necessity for every scheduled patient Communicates with management and clinics on any payer changes timely Communicates with physicians when there are questions and/or issues Work closely with clinics and scheduling team to prevent authorization denials Work all assigned accounts in a timely manner Enter authorization information on account Adapts quickly and willingly to new payer regulations Primarily involved in documentation, communication with insurance companies, and follow-up on authorization status Collaborates with clinical staff primarily for gathering necessary information for authorization and will have limited involvement in direct patient care and clinical discussions.
Competitive Health, Dental, and Vision Insurance
Short & Long Term Insurance
Life Insurance
Paid Time Off
Matching Retirement Plan
Tuition Reimbursement
Free Parking
Career Growth and more!
