Prior Authorization Specialist

PUTNAM COUNTY HOSPITAL•Greencastle, IN

3d•Onsite

About The Position

The prior authorization specialist is responsible for prior authorization operations within the primary care clinics, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization, coordinating prior authorization functions with all other departments.

Requirements

Strong customer service focus
Strong verbal and written communication skills
Able to work as part of a team and independently
Strong organizational and time management skills
Able to prioritize effectively including medical triage prioritization
Good judgement, resourcefulness, and problem solving abilities
Able to take initiative and follow through with delegated tasks
Able to act with integrity, professionalism, and confidentiality
Strong attention to detail
Strong proficiency in medical terminology & abbreviations

Nice To Haves

Knowledge of prior authorizations process for different services (radiology, pharmacology & laboratory services) and insurance providers (commercial, Medicare & Medicaid)
Solid understanding and knowledge of payer contractual requirements
Experience with insurance verification
Experience and familiarity with using insurance portals
Previous clinical support experience in a healthcare setting with basic knowledge of CPT & ICD 10 codes
Working knowledge of anatomy, physiology & the disease process to effectively communicate medical necessity criteria for procedures ordered or to effectively appeal an adverse determination

Responsibilities

Obtain prior authorizations for imaging and procedures from appropriate payors.
Maintain ongoing tracking and appropriate documentation on prior authorizations to promote team awareness and ensure patient safety
Ensure complete and accurate registration, including patient demographic and current insurance information
Assemble information concerning patient's clinical background and referral needs.
Provide appropriate clinical information to specialist per referral guidelines.
Contact review organizations and insurance companies to ensure prior approval requirements are met.
Present necessary medical information such as history, diagnosis and prognosis.
Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians
Review details and expectations about the prior authorization with patients as needed
Ensure that prior authorizations are addressed in a timely manner
Identify and utilize cultural and community resources.
Establish and maintain relationships with identified service providers
Abide by HIPPA and Hospital policies & procedures
Assists with Referrals as needed
Performs other duties as assigned