Prior Authorization Specialist I

Fisher Titus Medical Center • Norwalk, OH

3d

About The Position

The Prior Authorization Specialist I is responsible for ensuring that payers are prepared to reimburse Fisher-Titus for services in accordance with the payer-provided contract. The Specialist contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. Verifies patients' insurance and benefits information Obtains prior authorization from third-party payers in accordance with payer requirements Will contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary Works with other departments to gather the clinical information required by the payer to authorize services Maintains accurate records of authorizations within the EMR Identifies patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage (ABNs) Refers accounts to financial counseling as needed if authorization is not obtained Works directly with and supports the needs of the Denial/Appeals committee. Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality Continually maintains professional tone when communicating with patients and payer representatives Performs other clerical duties as requested

Requirements

• Associates or better in Business Administration

Responsibilities

• Ensuring that payers are prepared to reimburse Fisher-Titus for services
• Contacting payers to request service authorization
• Collecting financial and/or demographic information from patients as needed
• Verifying patients' insurance and benefits information
• Obtaining prior authorization from third-party payers
• Contacting patients to gather demographic and insurance information
• Updating patient information within the EMR
• Working with other departments to gather clinical information
• Maintaining accurate records of authorizations within the EMR
• Identifying patients who need Medicare ABNs
• Referring accounts to financial counseling
• Supporting the Denial/Appeals committee
• Complying with HIPAA regulations
• Performing other clerical duties as requested

Benefits

• Medical & Dental coverage
• 401K match
• paid time off
• tuition assistance
• Shift, Weekend & PRN differential

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree