Prior Authorization Specialist - Veterans Affairs (VA)

Neuroscience Group • Appleton, WI

319d

About The Position

Neuroscience Group is growing! We have a newly created full time position available for a Prior Authorization Specialist that specializes in VA Prior Authorizations. As an integral member of the Clinical Services Team, the VA Prior Authorization Specialist is responsible for authorizing ancillary testing and treatment conducted in the Neuroscience Group office and outside the office setting. This includes office visits to be scheduled within VA auth date range. This position includes verification of diagnosis driven authorization as it applies to what specialty to be covered. For over thirty years, Neuroscience Group has provided excellent neurologic care for the Fox Valley and Northeast Wisconsin. Ours is the only medical facility in the area that combines neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management, and physical therapy. Our practice has grown to over 50 providers and serves patients in nine outlying clinics scattered throughout the region. Our mission is to improve lives by providing the very best in brain, spine and pain care and we do that by living our company core values: personal care and compassion, teamwork, fiscal responsibility, continuous learning and improvement, initiative and leadership and community involvement.

Requirements

• Basic computer knowledge and keyboarding skills
• Medical terminology
• Excellent communication skills
• Customer service experience
• Strong organizational skills
• Detail – oriented
• Ability to multi-task and work well in a fast-paced setting
• Critical thinking skills and decisive judgment
• Knowledge of VA process, and clinical documentation needed to receive approvals in a timely manner

Nice To Haves

• Previous experience in preauthorization / precertification and VA request for services forms & standards of work
• Knowledge of insurance and third party payers
• Previous experience with CPT and ICD-10 coding
• Prior EPIC experience
• Prior HSRM (VA portal) experience
• Knowledge of VA authorizations / diagnosis driven auths
• Knowledge of testing to be discussed with VA clinical staff for coverage

Responsibilities

• Collects and reviews all patient VA referral / authorization information, diagnosis & specialty driven
• Submits Requests for Services (RFS) if scheduled outside auth window, continuation of care, if referred to another specialty, or if testing not covered in current SEOC (Specialized Episode of Care) list
• Determines medical necessity for authorization of ancillary tests (CT, MRI, EEG, EMG, etc.), treatment and/or procedure(s) conducted in the Neuroscience Group office and outside locations
• Upon receiving the anticipated procedure codes from the Provider, verifies active coverage for patient of said procedures in VA SEOC / VA portal (HSRM) / Optum
• Ensures that ALL pertinent information is available to be submitted to VA to be attached with the RFS (Request for service)
• Notifies patients and practitioners of any services that are not authorized by VA
• Informs patient of referral status in relationship to procedures / testing / office visits
• Maintains good communication with the patient, physician, clinical services team, reimbursement services team, surgical and hospital staff
• Routes encounters to correct pool or team per guidelines
• Maintains timely, accurate, uniform documentation (per Standard of Work) and record keeping to ensure accurate continuity of patient care
• Answers incoming calls related to VA and prior authorization using proper telephone etiquette (AIDET)
• Regularly attends all team and staff meetings
• Ability to upload VA and other auth information into patients chart accurately via Media Manager / following HIPAA protocol
• Stays current with process, procedure and clinic changes and updates relative to role

Benefits

• Health Insurance
• Health Savings Accounts with a generous employer contribution
• Dental Insurance
• Vision Insurance
• Company paid Long Term Disability and Life Insurance
• Voluntary Life and Short-Term Disability Insurance
• Voluntary Accident and Critical Illness Insurance
• Generous PTO and Sick Banks
• 401(k) with guaranteed employer contribution, Profit Sharing, and a Cash Balance Pension Plan
• Employee Assistance Program
• Timber Rattler tickets
• Holiday party, summer picnic, and annual recognition for years of service
• Annual Employee Appreciation Day

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level