Prior Authorization Specialist

Pacific Neuropsychiatric Specialists Inc • Irvine, CA

1d • Onsite

About The Position

We are seeking a motivated and like-minded Health Information Specialist. This is a full-time, in-office position. The Health Information Specialist will manage and maintain the accuracy, security, and privacy of electronic, and paper-based, medical records, manage data quality, and ensure compliance with legal and industry standards. This person will also be responsible for helping with our prior authorizations department by discussing medications, insurance, and prior authorization documents with patients, getting prior authorization approval from insurance companies, filing appeals, and ensuring completeness and accuracy on all prior authorizations.

Requirements

• Prior Authorization experience is required
• Experienced with knowing how to submit requests to insurance companies and follow up
• very familiar with the insurance plans - HMO and PPO
• Previous experience working in a medical/psychiatric facility
• Excellent communication skills, both written and oral.
• Proficient telephone and computer skills.
• Must be able to prioritize multiple tasks at once, and deal with high stress levels in an environment of changing priorities.

Responsibilities

• Submitting requests to insurance companies, gathering necessary documents, completing forms and following up on the status of the requests.
• Provide updates on the authorization, review requests for completeness and ensure all supporting documents are submitted to expedite approvals.
• Receive requests for prior authorizations and ensure that they are properly and closely monitored within company-set standards.
• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is completed.
• Collaborate with other departments to assist in obtaining prior authorizations/appeals.
• Document all interactions with insurance companies within the EMR system.
• Proactively work on prior authorizations that are due to expire.
• Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.

Benefits

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed