Prior Authorization Specialist

Description

Reports to: Revenue Cycle Manager

Summary/Objective

Effectively obtain prior authorizations and/or referrals for office visits, ordered testing, and procedures.

Essential Functions

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Responsible for pulling provider schedules and outgoing referrals and obtaining daily authorizations in multi-specialty practice.
• Obtain patient insurance information and contact insurance carriers online or by phone to verify precertification requirements.
• Research clinical information from medical record needed to obtain prior authorizations from insurance companies.
• Communicating authorizations to hospitals and physicians.
• Required to stay current with CPT and diagnosis codes, insurance rules, and guidelines for prior authorization.
• Field any phone calls and emails related to authorizations and referrals.
  
  

Competencies

• Excellent organizational and problem-solving skills
• Demonstrates well developed interpersonal/communication skills necessary to interact effectively with internal and external customers
• Ability to evaluate a variety of patient situations and make timely decisions
• Must demonstrate ability to work in fast-paced, deadline-oriented environment, with minimal supervision, with the ability to meet deadlines is a must with constant communication required
• Strong computer skills, including basic keyboarding, experience with Microsoft Office software (Outlook, Work, Excel)
• Knowledge and understanding of CPT and ICD-10 coding process
• Ability to support and understand authorization processes
• Knowledge and/or willingness to understand insurance guidelines and requirements to successfully complete prior authorizations/pre-determinations
  
  

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Position Type/Expected Hours of Work

Full Time / Monday – Friday

Travel

None

Education and Experience

High School Diploma or equivalent

Minimum 3-5 years of experience in customer service preferred but not required.

Work Authorization/Security Clearance

Must be authorized to work in the US for any employer

AAP/EEO Statement

US Digestive Health is an Equal Opportunity Employer. USDH does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

*** Background Check Requirement ***

As a condition of employment, a complete background investigation will be conducted based on the rules of the specific State in which the employee is hired. Typically, the state investigative process includes a state and federal background check. In addition, a drug screen will be required. TB testing will also be required for all patient-facing roles.

EEO Statement

At US Digestive Health, employees and applicants are evaluated based on their qualifications, skills, and ability to perform the duties and responsibilities of the position. US Digestive Health is committed to assuring equal employment opportunities to all employees and applicants.

US Digestive Health is an equal opportunity employer. In accordance with applicable law, we prohibit discrimination based on race, color, religion, creed, gender, pregnancy or related medical conditions, age, national origin or ancestry, physical or mental disability, genetic information, sexual orientation, to include gay, lesbian, bisexual, transgender and gender identity, or any other consideration protected by federal, state or local laws. Our commitment to equal opportunity employment applies to all persons involved in our operations and prohibits unlawful discrimination by any employee, including supervisors and coworkers.

Disclaimer

This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice. The list of job responsibilities, skills, duties, requirements, and the like is not exhaustive, rather it is illustrative of the current essential functions required for the position.

This organization participates in E-Verify.

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9. E-Verify Works for Everyone For more information on E-Verify, or if you believe that your employer has violated its E-Verify responsibilities, please contact DHS.

Benefits

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance
  
  

Requirements

Education and Experience: High School Diploma or equivalent

Minimum 3-5 years of experience in customer service preferred but not required.