What are the responsibilities and job description for the Prior Authorization Specialist position at US Heart & Vascular?
US Heart and Vascular is in need of a Prior Authorizations Specialist to join our team in Franklin, TN.
Responsibilities
Ensures timely and accurate insurance authorizations are in place prior to services being rendered.- Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
- 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 record 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, clinical partners, financial counselors, and others as necessary to facilitate the authorization process.
- Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
- Completes accurate documentation in all applications.
- Follows departmental policies and procedures, when necessary, authorization is not obtained before the service date.
- Answers provider, staff, and patient questions surrounding insurance authorization requirements.
- Handles escalated authorization requests as needed.
- Provides team mentorship as needed.
- Works other departmental tasks as needed.
Requirements
- Familiarity with medical office procedures and billing practices
- Proficient in clinical documentation review for alignment with insurance authorization requirements
- Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws.
- Computer skills – good working knowledge of MS office
- Provide professional service to direct customers of USHV in all interactions.
- Manage daily tasks to ensure business needs are consistently met.
- High School Diploma or equivalent required
- Associate’s degree in healthcare administration or business administration preferred
- A minimum of 3-5 years' experience in the same role, or related field in a healthcare setting is required.
- eCW experience a plus.
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