Medical Prior Authorization Specialist - Hybrid
About The Position
The Prior Authorization Specialist (also called “preauthorization” and “precertification”) obtains approval for health care services or medications before care is provided. This position works closely with clients, insurance payers, providers, clinical staff, and patients to evaluate whether services are medically necessary and covered under the patient’s health plan. The Prior Authorization Specialist is responsible for obtaining authorizations for radiology exams, radiation oncology services, radiation therapy, procedures, and chemotherapy drugs. Previous radiation oncology (RadOnc) experience is strongly preferred, with knowledge of radiation oncology treatment workflows, terminology, and payer authorization requirements. The position is also responsible for accurately documenting and entering required information into applicable systems.
Requirements
- High school diploma or equivalent (GED).
- Prior radiation oncology (RadOnc) experience.
- Medical office experience/medical terminology preferred.
- Accurately maintains and adheres to all safety rules and regulations.
- Must be detail oriented and have problem solving abilities.
- Proficient in Microsoft Office preferred.
- Working knowledge/experience in electronic medical records and/ or other medical software if applicable.
- Must possess the ability to work with patients and family members in a confident, respectful, and socially professional manner.
- Must rely on experience and judgment to plan and accomplish goals.
- Excellent communication and organizational skills with the ability to work in a fast-paced environment; prioritize tasks and workloads.
- Performs other duties as assigned.
Nice To Haves
- Previous radiation oncology (RadOnc) experience is strongly preferred, with knowledge of radiation oncology treatment workflows, terminology, and payer authorization requirements.
Responsibilities
- Understanding of insurance requirements for prior authorization, including requirements specific to radiation oncology services and treatments.
- Understanding of payer processes (website, fax, contact number) to submit appropriate authorization request
- Understanding of insurance billing procedures and practices
- Finding and understanding clinical information from EMR regarding services to be rendered
- Contacting payers to obtain prior authorization
- Following policy and procedures on treatment therapies and substitutions
- Advising providers and their clinical staff when issues arise relating to obtaining prior authorization
- Navigating and using national medical guideline tools
- Verifying that all insurance requirements have been met before noting approvals
- Following the workflow process on all pending cases
- Serving as primary contact with outside facility request with our clients
- Responding to all client emails and calls within the agreed upon policy timeframe
- Noting and applying all authorization correspondence in both PM and EMR systems
- Maintains the practices and principles set forth by AC3 leadership with a strong commitment to service, excellence, and quality.
- Maintains professional behavior, confidentiality, and discretion always, along with the ability to work with all levels of staff with a confident and professional demeanor.
- Follows HIPPA rules and regulations.
Benefits
- medical
- dental
- vision
- employer paid life insurance
- long-term disability policies
- short-term disability policies
- above average paid time out plan
- wellness program
- onsite biometrics
- ongoing mental and physical wellness support
- company sponsored financial wellness counselors
- employee assistance services
- company-matched, 401k plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
