Position Title: Prior Authorization Specialist
Department: Business Office
Supervisor's Title: HIM/Business Office Manager
IHA# Position Summary:
The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures performed at Valor Health. Developing and implementing prior authorization workflow, policies, and procedures. Principal Functions and Responsibilities:
- Contact insurance carriers to verify patient's insurance eligibility, benefits, and requirements.
- Request, follow up and secure prior authorizations prior to services being performed at Valor Health.
- Prioritize incoming authorization requests according to urgency.
- Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.
- When necessary, work with billing specialist to obtain a retro authorization.
- Assist with medical necessity documentation and submit medical records to expedite approvals and ensure that appropriate follow up is performed.
- Review accuracy and completeness of information requested and ensure that all supporting documents are present.
- Responsible for reviewing all encounters and mailing out Consolidated Summary of
- Attends and participates in meetings as requested.
- Performs other duties as assigned.