Prior Authorization Specialist

Cayuga Health System•Ithaca, NY

2d•$21 - $26•Onsite

About The Position

As an Authorization Specialist at Cayuga Medical Associates, you are responsible for reviewing physician orders, pharmacy documents and third-party technology platforms to ensure all aspects of the authorization process have been met. The position will be responsible for Initiating authorizations, conducting follow ups, and documenting pertinent information into appropriate systems to ensure patients are clear to receive their medications. The position requires integral communication with clinics, physicians, insurance companies, department administrators, and other departmental staff to ensure the ideal patient experience.

Requirements

Associate's degree (and two (2) year of relevant experience)
In lieu of an associate's degree, a HS diploma (or equivalent) with four (4) years of relevant experience
Two (2) years' experience of healthcare experience working for a health plan, physician practice, surgery center or hospital in a business capacity required.
Experience using Microsoft Office suite including Word and Excel.
A minimum of one (1) year minimum experience in obtaining authorization with a healthcare provider or insurance company required, data processing, hospital registration, insurance verification
Knowledge in Medical terminology, to include CPT/Diagnosis codes a MUST
Lifting up to 20 pounds, standing or sitting for extended periods of time, as well as repetitive use of hands and fingers.

Responsibilities

Initiate prior authorizations through fax or 3rd party sites.
Perform follow ups with insurance companies and obtain updates. Submit any additional information needed to ensure approval.
Validate insurance coverage and benefits.
Efficiently and accurately gathers and inputs patient/guarantor demographic and financial information.
Successfully adhere to financial policies and processes, act with integrity, good judgment, take initiative and pro-actively solve problems
Exhibits competency in the use of all registration systems, electronic verification tools and Web based resources.
Demonstrates a basic knowledge of third-party reimbursement requirements and regulations.
Demonstrates a positive and professional approach and communicates effectively with customers and team members at all times.
Consistently meets quality standards set by Revenue Cycle.
Meets departmental goals regarding collections, productivity and customer service.
Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental needs.
Meets federal, state and hospital requirements related to compliance issues.
Attends and participates in department staff meetings and attends other meetings as assigned
Other job-specific duties as assigned