Prior Authorization Specialist/Floating Triage Medical Assistant

VITALSKIN PHYSICIAN MANAGEMENT LLC•Prospect, KY

13d•$19 - $23

About The Position

This position will require a deep understanding of the PA process - specifically with biologic medications. This would include a thorough understanding of insurance plans, submit requests and maintain correspondence, and collaborating with provider groups. Candidate will need to be extremely organized and able to work independently. Will be available to assist 7-8 providers/clinical teams over multiple locations with PAs and triage tasks. Triage tasks to include phone calls, coordination of patient care with clinical provider teams, and patient assessment. Ability to fill in as a clinical team member when staffing issues arise This job description is not intended to be all-inclusive. Exact tasks and responsibilities may vary by location; employees are subject to the direction of management at the office, as assigned to meet the ongoing needs of the office and/or organization.

Requirements

2 years Dermatology Experience
High School Diploma or GED
Ability to read and interpret insurance coverage
Medical terminology
Excellent verbal, written, and interpersonal communication skills.
Proficient computer software skills ins MS suite and EPM/EHR.

Nice To Haves

Associate or bachelor’s degree
Two years insurance authorization experience

Responsibilities

Processes inbound and outbound authorizations and schedules corresponding specialty appointments using Practice management System (PMS) for patients and/or referring physician offices.
Obtains authorizations from various insurance carriers via phone, in writing, or email.
Responsible for reviewing denials and appropriately appealing to such denials.
Coordinates Care within the guidelines of multiple health plans, contracts, and insurance types.
Ensures efficient documentation of information for insurance verification, registration and billing requirements, and follows-up as needed.
Responds to inquiries as to current status of authorization by assessing the requests and evaluating the circumstances to provide the needed information,
Demonstrates superior customer service to all external and internal customers.
Communicates effectively with patients, physicians, and other departments regarding delays or issues relating to authorizations and patient appointments.
Demonstrate and promote a spirit of teamwork and cooperation.
Use initiative to improve skills, learn new skills, enhance knowledge, and improve communications.
Resolves coding edits within 24 hours and searches for long term solutions.
Reviews and corrects any errors or missing information on electronic claims, attaches necessary documentation for payment if required.
Keeps abreast of coding and reimbursement changes.
Tracks and reports ongoing issues with coding and documentation as discovered.
Train others as needed.