Medical Prior Authorization Specialist - Hybrid

AC3 Inc • South Bend, IN

6d • Hybrid

About The Position

The prior authorization (also called “preauthorization” and “precertification”) position obtains approval of a health care service or medication before the care is provided. He/ She works with the client, insurance, and patient to evaluate whether care is medically necessary and otherwise covered. This position obtains prior authorization for radiology exams, radiation therapy, procedures, and chemotherapy drugs. They will be responsible for documenting and entering required information in our systems.

Requirements

• High school diploma or equivalent (GED).
• 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

• Medical office experience/medical terminology preferred.
• Proficient in Microsoft Office preferred.

Responsibilities

• Understanding of insurance requirements for prior authorization
• 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 and vision health and wellness benefits
• employer paid life insurance, long and short-term disability policies
• above average paid time out plan
• comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support
• access to company sponsored financial wellness counselors, employee assistance services
• opportunity to enroll in our company-matched, 401k plan

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED