Prior-Authorization Specialist

BLACK RIVER HEALTH INC • Black River Falls, WI

13h • Onsite

About The Position

The Prior-Authorization Specialist works with various providers, departments, and insurance companies to facilitate prior-authorization and insurance benefit processes.

Requirements

• High School Diploma or General Education Degree (GED)
• Thorough knowledge of medical insurance coverage requirements and terminology
• Thorough knowledge of medical terminology, anatomy, and physiology
• Proficiently uses a computer and calculator
• Excellent oral and written communication skills
• Excellent interpersonal and customer service skills required
• Works well independently as well as in a team environment

Nice To Haves

• Two years of post-high school education with a concentration in accounting or business preferred

Responsibilities

• Reviews incoming provider orders for accuracy and completeness.
• Verifies insurance carrier information through online insurance portals, referring provider’s office, contacting patients, phone calls to payers, etc.
• Gathers and reviews supporting documentation needed for the prior authorization process - contacts the provider office to obtain missing information.
• Processes referrals according to insurance carrier requirements (submitting medical records, verbally relaying information, completing online and/or phone pre-authorization).
• Collaborates with other departments and providers to assist in obtaining prior authorization, keeping departments apprised of authorization status.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees