Prior Authorization Specialist (Lansdowne) 970

Comprehensive Sleep Care Center is seeking an experienced Prior Authorization Specialist to support our busy Sleep Center office in Leesburg, Virginia.

Primary Purpose

• Maintains, confirms and secures referrals, authorization, or pre-certifications required for patients to receive physician services, medical procedures and medication.
• Verifies the accuracy and completeness of patient account information.
• Maintains database of payer authorization requirements.

Major Responsibilities

• Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems.
• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.
• Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
• Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance. Notifies ordering providers if authorization/certification is denied.
• May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
• Maintains files for referral and insurance information, and enters referrals into the system.
• Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.

Knowledge, Skills & Abilities

• Knowledge of third-party payers and pre-authorization requirements.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / pre-certification / authorization processes.
• Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, physician practice management, and electronic medical records systems.
• Strong analytical, prioritization and organizational skills.
• Ability to work independently with minimal supervision and to manage multiple priorities.
• Exceptional communication and interpersonal skills with a high degree of diplomacy and tact.
• Ability to effectively communicate with a variety of people under stressful circumstances.

Experience:

• Insurance verification: 1 year (Preferred)
• eCW (eClinicalWorks): 1 year (Preferred)

Loudoun Medical Group provides competitive compensation and benefits including employer sponsored health, dental, vision, life, long-term disability, 401(k) and profit sharing. This is a great opportunity to work for a growing healthcare organization that employs over 350 medical providers throughout 35 medical and surgical specialties in over 148 clinical locations from Purcellville to Alexandria.

Job Type: Full-time

Pay: $20.00 - $22.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Insurance Verification: 1 year (Required)
• Insurance authorization: 1 year (Required)

Work Location: In person

Salary : $20 - $22