What are the responsibilities and job description for the Prior Authorization Specialist position at Rural Health Group, Inc.?
Rural Health Group is seeking a full-time Prior Authorization Specialist at our RHG @ Halifax Medical Specialist office.
REQUIREMENTS
A prior authorization specialist is an individual who is highly skilled in ensuring that patients receive the medication and/or diagnostic services that requires pre-authorization from insurance carriers. These individuals address and rectify rejected claims and conduct necessary third party authorization requests.
Successful candidate must demonstrate the Rural Health Group Core Competencies, which include:- Good Judgment
- Communication/Customer Service/Teamwork
- Passion
- Honesty
- Responsibility
- Job-Specific Skill Set
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
- Follow prior authorization work flow policies and procedures
- Collaborate with other departments to assist in obtaining prior authorizations.
- Review accuracy and completeness of information requested and ensure that all supporting documents are present
- Receive requests for prior authorizations and ensure that they are properly and closely monitored.
- Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes
- Manage correspondence with insurance companies, clinicians and patients as required
- Document all prior authorization information including approval dates, prior authorization number in hospital system
- Proactively work on prior authorizations that are timely
- Secure patients’ demographics and medical information by ensuring that all procedures are in sync with HIPAA compliance and regulation
- Advise providers and their clinical staff when issues arise relating to obtaining prior authorization
- Stay informed and research information regarding insurance criteria changes/updates for prior authorization
REQUIREMENTS
- High school diploma or GED.
- 2 years of related experience; prior- authorization experience highly desired
- Knowledge of medical terminology - Understanding of insurance requirements for prior authorization
- Experience in Radiology / Pharmacy / Laboratory Prior Authorizations
- Understanding of CPT codes and vast knowledge of insurance required
- Knowledge of eCW or other electronic health record preferred
- Knowledge of Commercial Payors, Medicare & Medicaid desired
- Excellent verbal, written, organizational and customer service skills
- Ability to work independently, meet deadlines and be flexible
- Ability to perform tasks accurately and efficiently when entering data electronically
- Proficient typing/keyboarding skills
- Basic knowledge of Microsoft Office, Excel and Outlook
- Physical Demands: Must be able to sit for long periods of time. Must be able to lift 25-50 pounds. Must be able to ambulate for extended periods of time.
- Embraces the team concept; encourages and models healthy, productive team behavior
- Bilingual (English/Spanish) is a plus, but not required - applicants who may serve in a translating capacity will be required to take a language assessment
EOE. Federal and State Criminal Background Checks and Drug Screen required for all positions. The Influenza vaccine is a condition of employment.
E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.
E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.
