Prior Authorization Specialist

Lifepoint Health • Georgetown, KY

15h

About The Position

Under the general direction of the department director, the Physician Services Surgery Authorization Specialist will primarily be responsible for authorizing medical procedures for prospective patients by coordinating all aspects of the scheduling cycle. This will initially include order intake via phone queue and fax as well as insurance benefit verification. Additionally, the position requires an ability to handle clinical assessment and insurance authorizations that are necessary preconditions for qualifying patients both medically and financially for final appointment confirmation. This position will also involve a basic understanding of insurance material such as claims, denial resolution, and appeals as needed. This position reflects a “help desk” approach to authorizing by actively responding to the general needs of the ordering physician’s and their patients.

Requirements

• High School Diploma or equivalent
• 3-4 years experience in a medical environment (hospital ancillary department, doctor’s office, x-ray lab), preferably with additional exposure to a related field such as registration, claims and patient financial services, or other ancillary department experience, etc.
• Must possess a working knowledge of commonly used healthcare concepts, practices, and procedures with particular emphasis on Outpatient Services.
• Requires a demonstrated ability to evaluate a patient’s medical history via chart notes or other clinical source and accurately apply it to commercial insurance utilization criteria.
• Must be able to stand, walk, and conduct frequent face-to-face encounters with patients and medical staff throughout the hospital for a significant portion of the workday when required.
• Requires excellence in customer service and telephone etiquette.
• Basic to intermediate math calculation, writing, and spelling skills are essential.
• Requires intermediate computer knowledge and the ability to utilize software applications such as Microsoft Office, Internet Explorer, and additional software programs as required.

Nice To Haves

• Associate’s degree
• Any special knowledge, skills, certification, or training will be particularly valuable (e.g. Bilingual (Spanish/English), coding certificate, prior clinical background, prior managed care employment, etc).
• 1 year in customer service or similar role. Familiar with call center environment preferred

Responsibilities

• Authorizing medical procedures for prospective patients by coordinating all aspects of the scheduling cycle.
• Order intake via phone queue and fax as well as insurance benefit verification.
• Handle clinical assessment and insurance authorizations that are necessary preconditions for qualifying patients both medically and financially for final appointment confirmation.
• Basic understanding of insurance material such as claims, denial resolution, and appeals as needed.
• Actively responding to the general needs of the ordering physician’s and their patients.
• Participate in receiving phone calls via a department telephone queue.
• Uses clinical knowledge to receive orders for review and clarification when needed, including medical necessity checking for all Medicare patients.
• Integrate a variety of clinical data, assess, and conduct medical necessity reviews with appointed utilization review departments.
• Exchanging clinical information with clinic staff and physicians and negotiating the best possible outcome or alternative modality.
• Transfer patient data in a reliable and consistent manner within regulatory guidelines.
• Work in a culturally diverse work environment and display a sensitive approach toward those with learning disabilities or other communication challenges.

Benefits

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program – mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• Options for accident, critical illness, long-term, short-term, and hospital indemnity insurance
• Professional development opportunities
• Free Parking
• And much more…

What This Job Offers

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