Prior Authorization Specialist

US Digestive Health • Wyomissing, PA

1d • Onsite

About The Position

Summary/Objective
Effectively obtain prior authorizations and/or referrals for office visits, ordered testing, and procedures.

Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Responsible for pulling provider schedules and outgoing referrals and obtaining daily authorizations in multi-specialty practice.
Obtain patient insurance information and contact insurance carriers online or by phone to verify precertification requirements.
Research clinical information from medical record needed to obtain prior authorizations from insurance companies.
Communicating authorizations to hospitals and physicians.
Required to stay current with CPT and diagnosis codes, insurance rules, and guidelines for prior authorization.
Field any phone calls and emails related to authorizations and referrals.

Requirements

• High School Diploma or GED equivalent
• Excellent organizational and problem-solving skills
• Demonstrates well developed interpersonal/communication skills necessary to interact effectively with internal and external customers
• Ability to evaluate a variety of patient situations and make timely decisions
• Must demonstrate ability to work in fast-paced, deadline-oriented environment, with minimal supervision, with the ability to meet deadlines is a must with constant communication required
• Strong computer skills, including basic keyboarding, experience with Microsoft Office software (Outlook, Work, Excel)
• Knowledge and understanding of CPT and ICD-10 coding process
• Ability to support and understand authorization processes
• Knowledge and/or willingness to understand insurance guidelines and requirements to successfully complete prior authorizations/pre-determinations
• Must be authorized to work in the US for any employer

Nice To Haves

• Minimum 3-5 years of experience in customer service preferred but not required.

Responsibilities

• Responsible for pulling provider schedules and outgoing referrals and obtaining daily authorizations in multi-specialty practice.
• Obtain patient insurance information and contact insurance carriers online or by phone to verify precertification requirements.
• Research clinical information from medical record needed to obtain prior authorizations from insurance companies.
• Communicating authorizations to hospitals and physicians.
• Required to stay current with CPT and diagnosis codes, insurance rules, and guidelines for prior authorization.
• Field any phone calls and emails related to authorizations and referrals.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED