Prior Authorization Specialist (Remote Eligible)

Brief Description

General Purpose

The Prior Authorization Specialist provides prior authorization support for behavioral health services provided within the organization from a multidisciplinary team.

To perform this job successfully, and individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Duties/Responsibilities

• Initiates prior authorizations as needed with insurance companies as well as retro authorizations and single case agreements.
• Collaborate with medical records, medical providers and/or additional service providers to coordinate care and initiate insurance authorizations as needed.
• Documents in EHR all patient contacts, insurance contacts, and other important information related to prior authorizations.
• Completes CCARS and DACODS.
• Insurance verification and eligibility checks.
• Serves as an information resource to clinical and intake teams, communicating often and effectively.
• Work as part of a multidisciplinary team.
• Participates in job-related training sessions and seminars.
• Attends required staff meetings and maintains prompt and regular attendance.
• Performs other duties as assigned.
  
  

Supervisory Duties (if any)

• None
  
  

Job Qualifications

Knowledge, Skills, and Ability:

• Possesses excellent organizational skills.
• Knowledge of specific medical/psychiatric illnesses, procedures and treatments.
• Excellent interpersonal skills including negotiation skills necessary to work within a team, and with insurance companies
• Knowledge of community agencies/resources.
• Ability to advocate/negotiate systems for/with patients.
• Ability to multitask under stressful situations.
• Proficient in Windows and Microsoft Office Software.
• Ability to be flexible in work schedule working weekends as well as be self-directed to prioritize and complete tasks.
• Ability to work in a busy, high-stress environment.
• Ability to prepare and maintain accurate records.
• Ability to interpret rules and regulations and understand client records.
• Ability to work tactfully and effectively with all constituents.
• Ability to prepare clear and concise reports using correct grammar, punctuation, and spelling.
• Ability to maintain objectivity and confidentiality.
  
  

Education or Formal Training:

• HS diploma or GED
  
  

Experience

• An ideal candidate will have insurance verification experience and a general understanding of prior authorization requirements. DACOD and CCAR experience preferred but not required.
  
  

Working Conditions And Other Conditions Of Employment

Working Environment:

This job operates in a fast-paced, professional office environment and routinely requires the use of standard office equipment such as computers, phones, photocopiers. The position may require travel to conferences, meetings and branch locations on a regular or intermittent basis. Work may involve moderate exposure to unusual elements, such as extreme temperatures, dirt, dust, fumes, smoke, unpleasant odors, and/or loud noises. In the health center environment, there is potential for contact with blood-borne pathogens and communicable diseases, as well as potential for contact with dissatisfied or abusive individuals. There could be interaction with persons who are mentally ill, disabled, elderly and emotionally upset.

Physical Activities:

These are representative of those which must be met to successfully perform the essential functions of this job.

This is a largely sedentary role but can involve standing or sitting for extended periods of time, bending at the waist, and using hands and fingers to handle and file papers or operate assigned equipment. While performing the duties of this job, the employee is regularly required to talk or hear. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus. Employee may also have to lift 10 to 25 lbs. unassisted.

Conditions of Employment:

• Annual TB, federally required drug screening, and Influenza vaccination or compliance with policy and procedure.
• Required possession of a valid state driver's license.
• Successful candidate must submit to and pass, post-offer drug screen.
  
  

Requirements

Work Schedule: Wednesday - Sunday 8am-5pm

Summary

All jobs are posted internally and externally a minimum of 5 business days. Jobs posted are open positions needed to be filled.

Summary Of Benefits

(Does not apply to internships or contractors)

Insurance Coverage

• Life insurance
• Medical and behavioral health
• Dental
• Vision
• Deductible reimbursement plan
• 6% employer match retirement 100% vested after just one year
• Optional insurance coverage available on a shared-cost basis
• Flexible spending plans for health, dependent, and elder care
• Optional Health Savings Account plan
  
  

Vacation & Education

• Generous paid time off benefit
• 10 paid holidays
• Paid Sick time
• Solvista Health offers internships for master’s level students in the behavioral health field
• Progressive skills enhancement training
  
  

Reimbursements

• Monthly stipend for fitness club membership
• Discounted membership for Crossfit Cañon City
• Clinical licensure reimbursement
  
  

Loan Forgiveness

Student loan repayment programs available through:

• National Health Service Corps Active Sites
• Nurse Corps Active Sites
• NHSC STAR LRP Active Sites
• Colorado Health Service Corps
• Public Student Loan Forgiveness
  
  

Summary Of Compensation

The base compensation represents the entry point of the range. Actual salaries will vary and may be above or below the range based on factors including but not limited to location, experience, education and performance. The salary is just one component of Solvista Health's total compensation package for employees.

For position openings where sign-on bonus is present, any former employee who seperated within the last 180 days is ineligible for said bonus option.

Summary Of Equal Opportunities And Accommodations

Solvista Health is deeply committed to building a workplace and community where inclusion is not only valued, but prioritized. We're proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

We are committed to providing reasonable accommodations to qualified individuals with disabilities in the employment application process. To request an accommodation, please contact Human Resources at [email protected], or by phone at 719-275-2351.





https://solvistahealth.org/careers/