Job Title: Prior Authorizations Specialist Job Summary: The prior authorization specialist will assist patients who need treatment requiring insurance carrier pre-authorization. They interview patients to assess their medication needs and liaise with insurance companies and nurse managers for prior authorization approval. Duties/Responsibilities: - Accurately carries out the responsibility for verifying patient insurance coverage, and ensures that necessary visits and procedures are covered by an individual’s provider.
- Responsible for entering data in an accurate manner, updating patient benefit information and verifying that existing information is accurate.
- Demonstrates proficiency in working with insurance companies, and has extensive knowledge of different types of coverage and policies.
- Demonstrates excellent multitasking skills, with the ability to work on many projects at once. Is very detail-oriented and organized, and maintains accurate patient insurance records.
- Possesses the ability to focus and work quickly. Ensuring that paperwork is processed in a timely manner.
- Serves as a trusted resource to patients, providing them with pertinent information regarding their coverage.
- Uses good judgement in contacting the patient for discovered unforeseen issues (i.e. anticipated procedure not covered, large co-pay or co-insurance, patient’s insurance premium was not paid)
- Utilizes patient chart on an as needed basis, accessing only information related to treatment, payment, and health operations.
- Comply with HIPPA confidentiality standards when accessing or communicating patient information
- Other duties as assigned by supervisor, manager or physician
Required Skills/Abilities: - Excellent verbal and written communication skills
- Ability to interact with patients and employees in a courteous, professional manner at all times
- Excellent organizational skills and attention to detail
- Ability to multi-task and function well in a high-paced and at times stressful environment
Education and Experience: High School Diploma or equivalent Healthcare receptionist experience preferred Physical Requirements: Prolonged periods of sitting at a desk, working on a computer Repetitive hand movements (specifically keyboarding and writing) Travel to other offices as needed
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