Prior Authorization Specialist- Must have Epic and Clinical Office experience

Carle Health•Champaign, IL

1d•$18 - $29

About The Position

Under the direct supervision of the manager, performs assigned duties, including telephonic support for on-line authorization of routine services, contacting specialty area providers, monitoring patient eligibility, and performing on-line data entry of routine authorizations/denials.

Requirements

Epic experience
Clinical Office experience

Responsibilities

Serves as department expert for prior authorizations
Establishes effective rapport and work closely with QA, HCC, Administration, Clinical, Patients, Families, and Billing Teams to ensure that all patients have authorization for services performed.
Contacts providers with authorization, denial and appeals process as applicable.
Verifies eligibility and authorization needs of current patients for continued services.
Works from spreadsheets in determining authorization needs.
Performs telephonic and on-line authorization requests for our services.
Identifies, processes, and communicates the completion of all department patient accounts/orders that require insurance verification, prior authorization, and/or pre-certification in a timely manner
Assists in gathering information needed for clinical staff to determine continued services.
Assists in educating and acts as a resource to clinical and non-clinical departments.
Assists with the identification and reporting of potential quality management issues.
Accurately enter required information into all applicable systems.
Uses Diagnosis Coding, HCPCS, Revenue and CPT coding.
Meets specified deadlines as required for continued patient satisfaction.
Demonstrates a professional image in dealing with the public, patients, families and payors.
Maintains regular and consistent attendance at work.
Behaves in a manner consistent with Mission, Vision, Values and Expectations for Excellence.
Maintains compliance with OSHA, Accreditation Standards and Risk Management guidelines.
Maintains compliance with Personnel policies and procedures.
Behaves in a manner consistent with all Corporate Compliance policies and procedures.
Meets measures as determined and required for job productivity and performance improvement.
Completes communication tasks and activities in a timely manner. This would include, but is not limited to: responding to email, voicemail or telephone messages, promptly, accurately, and professionally; attending staff meetings as scheduled or viewing videotapes of those meetings; asking questions of team members and supervisors when needing clarification about various day-to-day issues or patient needs; and reviewing employee communication pieces.
Performs other duties as requested by the Manager