What are the responsibilities and job description for the Prior Authorization Specialist (FT) (Hybrid) position at Ohio Valley Surgical Hospital?
Prior Authorization Specialist (Full-time) (Hybrid)
We look forward to finding new team members with the commitment and talent to help us provide excellent care for our patients as the best quality, value and choice in the region. At Ohio Valley Surgical Hospital, our mission is to Elevate the Standard of Health Care in Our Community, and our core values guide the way we fulfill our mission. In service to each patient, we value quality, compassion, and care you can trust.
The Prior Authorization Specialist position maintains, confirms, and secures referrals, authorizations, or pre-certifications required for patients to receive physician services, medical procedures, and PT/OT services. This position verifies the accuracy and completeness of patient account information and maintains the database of payer authorization requirements.
RESPONSIBILITIES:
We look forward to finding new team members with the commitment and talent to help us provide excellent care for our patients as the best quality, value and choice in the region. At Ohio Valley Surgical Hospital, our mission is to Elevate the Standard of Health Care in Our Community, and our core values guide the way we fulfill our mission. In service to each patient, we value quality, compassion, and care you can trust.
The Prior Authorization Specialist position maintains, confirms, and secures referrals, authorizations, or pre-certifications required for patients to receive physician services, medical procedures, and PT/OT services. This position verifies the accuracy and completeness of patient account information and maintains the database of payer authorization requirements.
RESPONSIBILITIES:
- Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/online 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 that all required services have prior authorizations and updates patients on their preauthorization status if needed. 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.
- Other duties as assigned.
QUALIFICATIONS:
- High school graduate
- Knowledge of third-party payers and pre-authorization requirements.
- Understanding of basic 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.
- Previous Insurance verification experience encouraged.
