Prior Authorization Specialist I (On-Site)
About The Position
The Prior Authorization Specialist I manages diagnostic and procedure orders, including completing prior authorizations, scheduling appointments, obtaining order results, and submitting results to the ordering provider. The role also assists patients with applications for programs that help meet the financial obligations associated with screening exams and schedules in-house diagnostic exams. The position requires courteous, respectful service to patients and family members, protection of patient confidentiality in accordance with organizational policies and HIPAA requirements, and communication through appropriate channels. The employee is expected to uphold the organization’s core values of dignity and stewardship while supporting patients and maintaining responsible use of organizational resources.
Requirements
- High school diploma or equivalent.
- Ability to communicate through appropriate channels and follow the proper chain of command for patient complaints.
- Ability to handle emergency situations calmly and effectively.
- Computer literacy and ability to navigate an Electronic Health Record.
- Ability to maintain good interpersonal relationships with coworkers and other members of the healthcare team and organization.
- Social and cultural sensitivity appropriate to an ethnically and economically diverse patient and employee base.
Nice To Haves
- At least 1 year of experience in a healthcare setting.
- Knowledge of insurance processes and medical terminology.
Responsibilities
- Review orders in the Electronic Health Record System and check with insurance companies to determine whether prior authorization is required.
- Process prior authorizations and send supporting documentation to insurance companies to expedite the process.
- Schedule diagnostic imaging and procedure appointments internally or externally according to patient needs.
- Manage correspondence with insurance companies, physicians, specialists, and patients as needed, documenting communications in the EHR as appropriate.
- Review denials and follow up with providers to obtain medically necessary information for appeals.
- Prioritize orders according to urgency.
- Request order results from external facilities and submit results to the ordering provider to support continuity of care.
- Assist patients with program applications to finance screening diagnostic imaging exams.
- Provide customer service in accordance with the organization’s mission and interact courteously and respectfully with patients and family members.
- Maintain patient confidentiality in accordance with organizational policy and procedure and HIPAA requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
