Prior Authorization Specialist
About The Position
Refuah Health is a federally qualified health center offering comprehensive care in Rockland and Sullivan Counties. We are over one hundred healthcare professionals strong with three decades’ experience providing unparalleled patient care. As an FQHC, we specialize in accessible and affordable care for low income and high-risk residents. We believe in the power of people to create great care and we are inviting the best to build their career with us! The Prior Authorization Specialist is responsible for obtaining pre-certifications and authorizations for Refuah patients. They take ownership and serve as the last line of defense against errors.
Requirements
- High School Diploma
- Knowledge of the health care field with regards to insurance carrier regulations
- Prior experience as a Medical Assistant
- Willingness and ability to quickly learn new software systems and workflows
- Comfort with, and reliability in, performing repetitive or detail‑oriented (tedious) tasks accurately and efficiently.
- Good interpersonal and communication skills
- Ability to project a pleasant and professional image
- Ability to effectively manage conflicts and resolve problems
Nice To Haves
- No experience required. Full training provided.
Responsibilities
- Contact insurance companies to verify benefits eligibility
- Collaborate with Refuah providers to resolve and appeal denied authorizations
- Ensure all services have prior authorizations.
- Utilize EMR system checking encounters when necessary and assign to the appropriate provider.
- Maintain knowledge of Medicaid and third party insurance requirements
- Verify insurance for in-network or out-of-network benefits
- Pre-certify services including surgery, office visits, diagnostic testing or any procedure that requires pre-certification
- Review Pediatric referrals from previous day and help schedule appointments
- Maintain strict patient confidentiality
- Maintain authorization records documentation
- Complies with applicable policies and procedures and supports the Compliance Program
- Contributes to organizational operations by performing other duties as may be required
Benefits
- Flexible schedules for maximum work-life balance
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
