Monitors advanced procedure trackers for each practice and identify opportunities to assist with the authorization process.
Collects all the necessary documentation to obtain prior authorization.
Reviews medical necessity guidelines for all procedures by Payor.
Contacts the practice for additional information and completion of the required prior authorization in order to proceed with procedures and medication requests.
Completes, timely, and accurate identification and submission of prior and retro authorization requests to the payors.
Interacts with pain practices, vendors, insurance companies, patients, and management, as necessary, to request for prior authorizations.
Documents account activity, updating patient and claim information and demonstrating proficiencies with the prior authorization system to ensure all functionalities are utilized for the most efficient processing of claims
Identifies prior authorization trends and/or issues resulting in delayed claims processing.
Provides the highest level of customer service to internal staff.
Serves as a backup to the Contact Center Team to receive inbound calls for patient scheduling as needed during peak hours of high call volume.
Performs other related duties as assigned.
High School Diploma or GED required.
At least one year of Prior Authorization and clinical setting experience required.
Excellent verbal and written communication skills.
Excellent organizational skills and attention to detail.
Strong analytical and problem-solving skills.
Proficient with Microsoft Office Suite or related software.
Extensive knowledge of the requirements of the HIPAA privacy and security rules.
Basic understanding of medical terminology.
Familiar with navigating payor portals to obtain authorization and medical policies.
Required to sit for long periods.
Must be able to communicate with or without reasonable accommodations – speak and hear.
Able to use both hands to finger, handle, or feel, and reach with hands and arms.
Frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus.
An Equal Opportunity Employer
We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.
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