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.
Position Qualifications/Requirements/preferences:
- Minimum Education: High school diploma or equivalent.
- Minimum of 3 years' experience working in healthcare.
- Minimum of 2 years' experience as a Medical Assistant/CAN/LPN
- Preferred experience with obtaining prior authorizations.
- Ability to communicate effectively with a wide variety of contacts at all levels of the organization.
- Must have strong organizational skills and attention to detail.
- Strong work ethic and ability to apply critical thinking to a variety of practical and time sensitive situations.
- Working knowledge of Microsoft Office including Word, Excel, and Outlook are required.
- Consistent professionalism in both presentation and demeanor.
- Ability to work with minimal supervision and as a member of a team.
- Ability to Flex Schedule to adjust to workflow.
Working Conditions:
- Primarily office work. Positions is flexible to be in suite, remote or hybrid.
- General Health care environment exposure to patient conditions.
- Physical Requirements: Standing, walking, bending, stooping, sitting, hand eye coordination, speaking.