Prior Authorization Specialist

Tanner Clinic•Kaysville, UT

4d•Onsite

About The Position

Essential Job Responsibilities: Obtains pre-authorizations/pre-certification per payer requirements for services and ensures authorization information is documented appropriately. Verifies physician orders are complete, determines CPT, HCPCS and ICD-10 codes for proper authorization. Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out-of-pocket expenses for point of service collections. Communication is maintained with providers, clinical staff, and patients in relationship to authorization status. Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes. Keep informed of changes in the authorization process and insurance policies Aid team members in maintaining turnaround times. Account for internal control responsibilities in line with the department objectives. Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA). Answer questions and offer other information, as requested, to provide patient-focused service and a positive impression of the organization. Other duties as assigned by the supervisor or manager.

Requirements

High school diploma or equivalent
Medical Assistant or higher
3-5 years of experience working in a hospital, doctor’s office, or pharmacy setting with knowledge of procedures and/or medication authorization experienced required.
Knowledge of CPT, HCPCS, and ICD-10 codes.
Knowledge of medical terminology and departmental services.
Basic computer skills (Microsoft Office Suite).
Basic problem-solving skills.
Possess pleasant and effective written, verbal, and telephone communication skills.
Must possess excellent time management and organizational skills.
Must possess multi-tasking skills.
Ability to maintain a professional demeanor during stressful situations.
Ability to solve conflict.
Ability to use multi-line phone system, including transferring calls and paging.
Prevents, calms, or defuses irate callers and patients by working with them to identify concerns and properly directs calls.
Regular and reliable attendance is an essential function of the job.

Nice To Haves

1-2 years procedure and/or medication authorization experience preferred.

Responsibilities

Obtains pre-authorizations/pre-certification per payer requirements for services and ensures authorization information is documented appropriately.
Verifies physician orders are complete, determines CPT, HCPCS and ICD-10 codes for proper authorization.
Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out-of-pocket expenses for point of service collections.
Communication is maintained with providers, clinical staff, and patients in relationship to authorization status.
Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.
Keep informed of changes in the authorization process and insurance policies
Aid team members in maintaining turnaround times.
Account for internal control responsibilities in line with the department objectives.
Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA).
Answer questions and offer other information, as requested, to provide patient-focused service and a positive impression of the organization.
Other duties as assigned by the supervisor or manager.