Medical Prior Authorization Specialist

AFC URGENT CARE

Hinsdale, IL

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JOB DETAILS

SKILLS

Analysis Skills, Clinical Information, Communication Skills, Computer Skills, Current Procedural Terminology (CPT), Customer Support/Service, Data Analysis, Demographics, Detail Oriented, Electronic Medical Records, Establish Priorities, Federal Laws and Regulations, HIPAA (Health Insurance Portability and Accountability Act), High School Diploma, Identify Issues, Insurance, Medical Records, Multitasking, Operations Processes, Pain Management, Patient Care, Patient Care Authorizations, Presentation/Verbal Skills, Problem Solving Skills, Procedure Development, State Laws and Regulations, Third-Party Payer, Typing, Writing Skills

LOCATION

Hinsdale, IL

POSTED

30+ days ago

Company Overview:

Modern Pain Consultants is a renowned Interventional Pain Practice committed to providing exceptional patient care and innovative pain management solutions. We are a well-established, higher volume Interventional Pain Practice seeking a seasoned, talented full-time Prior Authorization Specialist with a can-do attitude and strong professionalism. You must be computer savvy for this position. We are EMR – based, using EMA; Experience with EMA is very beneficial, but not required. Looking for candidates who want a long-term, stable position with opportunity for advancement.

Position Highlights:
The Prior Authorization Specialist is responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all payers. In addition, the Prior Authorization Specialist may be responsible for pre-appointment registration and insurance review to maximize the submission of a clean claim.

Position Responsibilities:
- Reviews, collects and properly records demographic and insurance information required to properly address the customers' authorization requirements and identify any financial issues. Verifies patient's eligibility from resources provided by third party payers and portals and other on lines services.

-Collects and analyzes demographic, insurance and other information from the patient, guarantor and all other sources to accurately obtain authorization for scheduled procedure.

-Assembles information concerning the patient's clinical background and clinical information that is required for the payer to issue a referral or an authorization. Per referral guidelines, provide appropriate clinical information to the payer.

-Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, CPT codes and clinical notes.

-Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy.

-Consistently maintains authorization accuracy rates at and or above department standard in performance of registration and authorization duties.

- Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.

- Receives and properly responds to, or directs telephone and electronic inquiries from patients, payers, physicians and their staff, internal department and other persons and entities.

-Ability to exercise good customer service skills when communicating with both our patients as well as our internal customers.

-Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.

-Performs other duties as assigned for the operational effectiveness and success of the department.

Required Job Qualifications:
- High school graduate or equivalent.
- 1 year of experience
- Excellent communication and outstanding customer service and listing skills.
- Basic keyboarding skills
- Ability to analyze and interpret data
- Critical thinking, sound judgment and strong problem-solving skills essential
- Team oriented, open minded, flexible, and willing to learn
- Strong attention to detail and accuracy required
- Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
- Ability to follow oral and written instructions and established procedures
- Ability to function independently and manage own time and work tasks
- Ability to maintain accuracy and consistency
- Ability to maintain confidentiality
- Experience in Pain Specialty is Preferred

About the Company

AFC URGENT CARE

Our Mission

With a mission to change the way urgent care is delivered in the United States, AFC Urgent Care Denver is a medical organization providing high-quality, compassionate urgent care to communities across the country. Our medicines treat aches and pains and our physicians treat people. We are constantly looking for better ways to do both. We strive for fresh thinking and best practices in the fields of urgent care and occupational medicine.

Our People

We share similar core values that drive us to bring the best of who we are to work every day. Every patient who walks through American Family Care doors deserves nothing less. These values include: a respect and consideration for others, honesty and integrity. It means compassion and kindness for all. Teamwork and a spirit of cooperation. Initiative and bringing excellence to everything we do. This is who we are.

Our Reputation

AFC Urgent Care Denver is known for advanced patient care provided by expert physicians and staff, particularly in the areas of urgent care and occupational medicine. Our ability to provide state-of-the-art treatment stems from our commitment to team work, collaboration and first class patient care. We believe in ourselves, medicine, our company, our co-workers and our patients.

Our Difference – High Tech Medicine with BALANCE

AFC Urgent Care Denver means BALANCE. Our ability to bring the best to medicine every day is enhanced by our commitment to balance. Our medical team is made up of professionals driven to provide the best patient care and committed to the principals of team work, kindness and balance. With balance, we grow as people and professionals.

COMPANY SIZE

50 to 99 employees

INDUSTRY

Healthcare Services

WEBSITE

https://afcurgentcaredenver.com/