What are the responsibilities and job description for the Prior Authorization Specialist position at Woodlawn Health?
SIGNING BONUS!
Join the Woodlawn Team as a Prior Authorization Specialist! Candidate must have one of the following: LPN, CMA, CCMA, or RMA credentials.
Our Mission is to provide excellent healthcare services by highly skilled staff in a compassionate and caring manner. We know that our employees are essential to the care we provide!
Our Core Values are as follows: Courtesy, Respect, Caring, Professionalism, Confidentiality, Integrity, and Accountability.
EDUCATIONAL REQUIREMENTS AND QUALIFICATIONS:
- One of the following credentials is required: LPN, CMA, CCMA, or RMA.
- Familiarity with medical terminology, knowledge of medical service coding, CPT and ICD-10 diagnosis found in procedure orders, human anatomy, specifically musculoskeletal, or the willingness/ability to learn quickly is preferred.
- We prefer candidate with two years of clinical preauthorization experience as well as two years of previous health insurance claims processing or health insurance billing experience.
- Strong computer skills with ability to work in Word, Excel, spreadsheets, PDF software, internet use and other common office and medical software required.
- Previous Electronic Medical Record (EMR) experience or the ability and willingness to learn how to use EMR software in addition to the ability to interpret clinical chart notes and compare to insurance company requirements for service required.
- Customer service experience and strong verbal communication skills.
- Strong time management skills, ability to prioritize multiple competing tasks, work independently, in addition to being a part of a team and leading a team required.
- Exemplary organizational skills required to plan priorities to meet deadlines.
PRIMARY DUTIES:
- Act as a primary resource for all departments/employees for preauthorization work/questions.
- Verify insurance coverage for health care services ordered or provided.
- Review clinical documents and get clarification on procedure, services, treatments(s) being ordered/performed when necessary.
- Prioritize incoming authorization requests according to urgency.
- Contact insurance company or other third party to obtain a precertification for procedures, services, and treatments including use of website or by phone and then follow-up regularly on pending approval cases.
- Document each step taken thoroughly and in a timely manner.
- Follow up once authorization is obtained and follow up clinical documentation to approve/denial/appeal.
- Assure preauthorization tools and knowledge base are current, functional, and encourages/assists other preauthorization specialists in their use.
- Assign appropriate codes to the procedure, services, treatments, and patient diagnosis by verifying them.
- In addition, work with provider, clinical department, as well as clinicians to clarify and document appropriate clinical data to facilitate authorization of payment for services as needed.
- Communicate with all departments necessary regarding precertification status.
- Initiate appeals for denied authorizations
- Additionally, contact patients to discuss authorization status.
Full-time, day shift, no weekends, no holidays!
BENEFITS:
- Sign-on Bonus / Sign On Bonus / Signing Bonus
- Medical
- Dental
- Vision
- Life Insurance & Disability
- 403 (b) with company match
- Vacation Time
- Sick Time
- FSA
Job Type: Full-time
Benefits:
- 403(b) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
