Prior Authorization Specialist I

Community Health Center of Southeast Kansas Inc • Fort Scott, KS

2d • Onsite

About The Position

The Prior Authorization Specialist I is responsible for diagnostic and procedure orders management, including completing prior authorizations, scheduling appointments, obtaining order results, and submitting results to the ordering provider. The Prior Authorization Specialists I assists patients with applications for programs to support the financial obligations needed to complete screening exams, and scheduling in-house diagnostic exams.

Requirements

• High school diploma or equivalent.
• Must be computer literate and able to navigate through the Electronic Health Record.
• Must be able to maintain good inter-personal relationship with co-workers and other members of the health care team and the organization.
• Provide customer service in accordance to the organization’s mission.
• Be courteous and respectful when interacting with patients and family members.
• Maintain patient confidentiality in accordance to organization’s policy and procedure and HIPAA requirements.

Nice To Haves

• At least 1 year of experience in a healthcare setting preferred.
• Knowledge of insurance processes and medical terminology preferred.
• Social and cultural sensitivity appropriate to ethnically and economically diverse patient-and employee-base.
• Ability to handle emergency situations calmly and effectively.

Responsibilities

• Reviews order within the Electronic Health Record System with insurance companies to determine need for prior authorization.
• Processes prior authorizations and sends any supporting documentation to insurance companies to expedite the prior authorization process.
• Schedules diagnostic imaging and procedure appointments appropriate for the patient’s needs, internally or externally.
• Manage correspondence with insurance companies, physicians, specialist and patients, as needed, including documenting in the EHR as appropriate.
• Reviews denials and follows up with the provider to obtain medically necessary information to submit an appeal of the denial.
• Prioritizes orders by level of urgency.
• Requests order results from external facilities and submits the results to the order provider to support continuation of care.
• Assists patients with program applications to finance screening diagnostic imaging exams.

What This Job Offers

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