What are the responsibilities and job description for the Prior Authorization Specialist position at PRIMARY CARE PARTNERS INC?
Job Details
Description
Centralized Prior Authorization Specialist
- We pay for 100% of your health insurance premium.
- Primary Care Partners strives to maintain a positive work life balance for every individual.
Job Summary:
Prior Authorization specialist is responsible for processing and submitting authorizations and ensures that all referrals and authorizations documents are completed and submitted in a timely manner. Communicate authorization denials to ordering physician.
Description:
The Pre-Authorization Specialist is a member of the Pre-Authorization Team who is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services/studies.
This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care.
The Pre-Authorization Specialist provides detailed and timely communication to both payers and care teams in order to facilitate compliance with payer requirements and is responsible for documenting the appropriate information in the patient's record.
Duties/Responsibilities:
- Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
- Successfully works with payers via electronic/telephonic and/or fax communications.
- Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services.
- Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits.
- Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
- Communicates with patients, care team, financial counselors, and others as necessary to facilitate authorization process.
- Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Completes accurate documentation of Auth/Cert.
- Completes notification to all payers via electronic/fax/telephonic means per policy.
- Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
- Follows departmental policies and procedures when necessary authorization is not obtained prior to service date.
- Answers provider, staff, and patient questions surrounding insurance authorization requirements. Discuss any insurance communication with patient or family members.
Work Experience:
Must have at least two (2) years of experience in the medical field and a minimum of one (1) year experience working with insurance companies. Up to one year of billing experience preferred.
Education Requirements:
High School Diploma or GED
General Requirements:
Exceptional customer relations skills required. Knowledge of online insurance eligibility systems. Excellent typing and computer skills. Familiarity with Medical Terminology. Demonstrated ability to efficiently organize work and maintain a high level of accuracy and productivity.
Position Type/Expected Hours of Work:
This is a full-time position at 40 hours a week. Works primarily Monday through Friday rotations of 8 a.m. to 5 p.m. with an hour lunch. Expected hours of work may change at any time with or without notice.
Risk Level:
Low exposure
Working Environment:
This job operates in a professional office environment. Located in a well-lighted, ventilated area.
Physical Demands:
The physical demands descripted here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk and hear. This is primarily a seated role with significant computer work, primarily standing and walking; light to moderate lifting. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.
Qualifications
Work Experience:
Must have at least two (2) years of experience in the medical field and a minimum of one (1) year experience working with insurance companies. Up to one year of billing experience preferred.
Education Requirements:
High School Diploma or GED
General Requirements:
Exceptional customer relations skills required. Knowledge of online insurance eligibility systems. Excellent typing and computer skills. Familiarity with Medical Terminology. Demonstrated ability to efficiently organize work and maintain a high level of accuracy and productivity.
Salary : $17
