Prior Authorization Specialist

Alpine Physicians•Denver, CO

13d•$20 - $26

About The Position

Are you looking to work for a company that has been recognized for over a decade as a Top Place to Work? Apply today to become a part of a company that continues to commit to putting our employees first. Job Description: Position Summary: Evaluates referral and pre-certification requests in accordance with contractual obligations. Regularly interacts with physician offices assisting with prior authorizations.

Requirements

High School diploma/GED
One to three years healthcare experience required (medical office, healthplan, etc.)
Knowledge of medical terminiology required
Knowledge of medical coding, NCQA and Medicare Guidelines required
Proven customer service skills required
Excellent written and verbal communications skills required
Skilled in computer competency using Microsoft Outlook, Word and Excel
Ability to work in a windows based environment utilizing numerous programs at once
Ability to work in a fast pace environment
Ability to identify and sovle practical problems
Ability to maintain positive and effective work relationships with coworkers, clients, members, and providers.
Strong organizational skills.
Strong attention to detail.
Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.

Nice To Haves

MA or Associates degree highly preferred
One to three years utilization management experience highly preferred

Responsibilities

Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.
Develops and maintains a good working relationship with team members, other departments, medical directors, and provider offices.
Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.
Answer phones regarding questions related to prior authorization.
Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow.
Follows documented process to review healthcare service requests.
Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.
Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.
Participates as a part of the Prior Authorization team by actively interacting with other team members to distribute work fairly and resolve issues.
Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.
Evaluates referral and pre-certification requests to determine eligibility and network affiliation.