Prior Authorization Specialist

Company Overview

Urology Specialists of the Carolinas is a leading healthcare provider formed by the merger of Charlotte Urology and Hawes Urology. With a legacy of compassionate urologic care spanning over two decades, our practice is dedicated to delivering the highest quality treatments and procedures, supported by specialists trained at top medical institutions.

Summary

Role and Responsibilities

Authorization Specialist duties may include:

• Determine if pre-certification or prior authorization is required for the requested service, which may include, but not be limited to, the following:
• Urolift, Rezum, Fusion Biopsy, Prostate Biopsy, PTNS, Xiaflex, Botox, Lupron, Firmagon, Eligard, Vasectomy
• Verify patient eligibility and insurance coverage details to ensure the treatment/procedure is covered under the patient’s plan.
• Obtain and submit necessary supporting documentation when required by insurance companies.
• Communicate with patients and physicians to provide information on precertification status, requirements, and potential denials or alternative options.
• Knowledgeable with changes in insurance policies, guidelines, and medical procedures to ensure accurate and timely precertification decisions.
• Assist with appeals related to precertification denials.
• Provides excellent customer service to internal and external customers by communicating effectively, responding timely, and providing resolution when needed.
• Enters all information in referrals and updates the patient chart.
• Understands patient education needs by effectively sharing information with patients and families.
• Works effectively as a team member and maintains effective working relationships with patients, employees, and the public.
• Collaborates with co-workers to ensure a smooth and efficient patient experience.
• Consistently demonstrates behaviors, conduct, and communication supporting company values.
• Maintain confidentiality of patient information and adhere to HIPAA regulations.
• Other Duties to support your team and ensure a positive patient experience.

Qualifications and Education Requirements

• High school diploma or general equivalency (GED),
• Minimum two years of administrative assistant experience in a medical office, including experience with insurance preauthorization.
• Excellent written and verbal communication skills.
• Excellent communication and interpersonal skills, with the ability to work effectively with patients, their families, and healthcare professionals at all levels.
• Computer competence and knowledge of EMR Systems.
• Ability to multitask, prioritize and manage time effectively.
• Empathetic and patient-focused approach to customer service.

Preferred Skills

• Knowledge of the Health care field and medical office protocols/procedures.
• Knowledge of medical terminology and insurance practices
• Knowledge of HIPPA regulations and compliance.
• Knowledge of CPT ICD9 and ICD10 coding.
• Skill in handling phone calls and triaging appropriately.

Physical Demands

• This job may require sitting or standing for extended periods and occasional bending, lifting, and reaching.
• Occasionally lift and carry up to 20 pounds.

Additional Notes

The job description is not designed to cover or contain a comprehensive listing of all duties or responsibilities required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time, with or without notice.

If you are passionate about healthcare and want to play a vital role in patient care, we invite you to apply today to join our dedicated team at Urology Specialists of the Carolinas!

Job Type: Full-time

Pay: $20.00 - $24.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Ability to Commute:

• Charlotte, NC 28262 (Required)

Ability to Relocate:

• Charlotte, NC 28262: Relocate before starting work (Required)

Work Location: In person

Salary : $20 - $24