Pre-Authorization Specialist - Pain Clinic | Part-Time, Shifts Vary

Phelps Health•Fishersville, VA

2d•Onsite

About The Position

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri. No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family. General Summary The Pre-Authorization Specialist performs assigned duties, including telephonic support for on-line authorization of routine services, contacting specialty care providers, monitoring patient eligibility, and performing on-line data entry of routine authorizations/denials.

Requirements

High school degree or equivalent.
Medical Terminology required.
Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions.
Normal mental concentration with repetitive operations for a long period of time.
Ability to stand, walk, sit, and reach.
Occasionally lifts and transports items weighing up to ten (10) pounds.

Nice To Haves

Bachelor's degree preferred.
Previous experience (usually 2+ years) in general office environment preferred.
Proficiency with computer systems, ICD-9/CPT coding, and multi-line phone systems preferred.

Responsibilities

Performs telephonic support for on-line authorization of routine services.
Provides direct support to primary care providers regarding utilization, authorization, and referral activities.
Proficient in the use of ICD-9 and CPT codes.
Gathers the proper information needed for coordinators/case managers to determine continued authorization.
Provides data entry for care which has been arranged by the Pre-Authorization Coordinators.
Contacts providers with authorization, denial and appeals process information.
May receive pended claims reports on claims received without prior authorization to research and review eligibility and benefit coverage.
Upon decision of claim payment status, generates the appropriate referral with notification and exchange of information to the service organization for proper adjudication of claim payment.
Assists with the identification and reporting of potential quality management issues.
Responsible for ensuring these issues are reported to the proper individuals.