Prior Authorization Specialist

Salem Regional Medical Center•Columbiana, OH

About The Position

The primary purpose of the Prior Authorization specialist is to communicate with the clinical staff, surgical schedulers, providers, and insurance companies to obtain authorizations and coordinate scheduling for upcoming procedures and/or surgeries for Firestone Ambulatory Surgery Center. This individual will work with various insurance companies to obtain eligibility, verify coverage of services to be performed and obtain pre-certifications for procedures/surgeries ordered. This individual will perform assigned duties in an efficient manner, in accordance with established procedures, and as directed by the manager of SCH Professional Corporation Revenue Cycle to assure that a successful, viable department is always maintained. The Prior Authorization Specialist is responsible for gathering appropriate information during the scheduling process, accurately and timely calling insurance companies for verification including benefit details, referral information, precertification/authorization, and determining patient financial responsibilities along with scheduling patients on the ASC scheduling system. This individual will work closely with the physician offices to ensure that proper information is obtained and processed in an efficient timely manner. This individual will also assist the physician offices and patients with any questions and concerns. This individual will perform these duties in a courteous and professional manner. This position will also require the employee to perform other related duties and activities assigned by your Director or Manager of the department.

Requirements

High School Diploma required
Medical terminology knowledge
Must have experience with clerical/office work
Must have knowledge of insurance company procedures
Strong phone and written communication skills
Customer Service
Ability to work well with co-workers and work as a team
Computer skills: Typing, Microsoft Word, Excel
Be able to make a change on demand and a multitasker

Responsibilities

Communicate with clinical staff, surgical schedulers, providers, and insurance companies to obtain authorizations
Coordinate scheduling for upcoming procedures and/or surgeries
Obtain eligibility and verify coverage of services
Obtain pre-certifications for procedures/surgeries
Gather information during the scheduling process
Accurately and timely call insurance companies for verification including benefit details, referral information, precertification/authorization
Determine patient financial responsibilities
Schedule patients on the ASC scheduling system
Assist physician offices and patients with any questions and concerns