What are the responsibilities and job description for the Prior Authorization Specialist - Veterans Affairs (VA) position at Neuroscience Group?
Job Description
Job Description
Description :
Neuroscience Group is growing! We have a newly created full time position available for a Prior Authorization Specialist that specializes in VA Prior Authorizations. As an integral member of the Clinical Services Team, the VA Prior Authorization Specialist is responsible for authorizing ancillary testing and treatment conducted in the Neuroscience Group office and outside the office setting. This includes office visits to be scheduled within VA auth date range. This position includes verification of diagnosis driven authorization as it applies to what specialty to be covered.
For over thirty years, Neuroscience Group has provided excellent neurologic care for the Fox Valley and Northeast Wisconsin. Ours is the only medical facility in the area that combines neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management, and physical therapy. Our practice has grown to over 50 providers and serves patients in nine outlying clinics scattered throughout the region. Our mission is to improve lives by providing the very best in brain, spine and pain care and we do that by living our company core values : personal care and compassion, teamwork, fiscal responsibility, continuous learning and improvement, initiative and leadership and community involvement.
Requirements : Essential Functions
- Collects and reviews all patient VA referral / authorization information, diagnosis & specialty driven
- Submits Requests for Services (RFS) if scheduled outside auth window, continuation of care, if referred to another specialty, or if testing not covered in current SEOC (Specialized Episode of Care) list
- Determines medical necessity for authorization of ancillary tests (CT, MRI, EEG, EMG, etc.), treatment and / or procedure(s) conducted in the Neuroscience Group office and outside locations
- Upon receiving the anticipated procedure codes from the Provider, verifies active coverage for patient of said procedures in VA SEOC / VA portal (HSRM) / Optum
- Ensures that ALL pertinent information is available to be submitted to VA to be attached with the RFS (Request for service)
- Notifies patients and practitioners of any services that are not authorized by VA
- Informs patient of referral status in relationship to procedures / testing / office visits
- Maintains good communication with the patient, physician, clinical services team, reimbursement services team, surgical and hospital staff.
- Routes encounters to correct pool or team per guidelines
- Maintains timely, accurate, uniform documentation (per Standard of Work) and record keeping to ensure accurate continuity of patient care
- Answers incoming calls related to VA and prior authorization using proper telephone etiquette (AIDET)
- Regularly attends all team and staff meetings
- Ability to upload VA and other auth information into patients chart accurately via Media Manager / following HIPAA protocol
- Stays current with process, procedure and clinic changes and updates relative to role
KNOWLEDGE / SKILLS PREFERRED TO BE SUCCESSFUL IN THIS POSITION
KNOWLEDGE / SKILLS REQUIRED TO BE SUCCESSFUL IN THIS POSITION
TYPICAL PHYSICAL DEMANDS AND WORKING CONDITIONS
BENEFITS
At Neuroscience Group we offer a very competitive salary. In addition to great pay, we also offer the following benefits :
