Prior Authorization Specialist

Current Career•Prescott Valley, AZ

8d•Hybrid

About The Position

The Prior Authorization Specialist works with all departments and insurance companies to obtain the necessary authorizations for services or medications that require prior-authorizations. Once received, authorization is communicated to staff and recoded into the EHR system to ensure proper billing. The Prior Authorization Specialist must maintain a high level of understanding of insurance companies and billing authorization requirements.

Requirements

21 years of age or older; or minimum 18 years old and licensed or certified under A.R.S. Title 32 and providing services within the personnel member’s scope of practice; or minimum 18 years old for select administrative positions
Must be able to provide or obtain an AZDPS Level One Fingerprint Clearance Card
Must possess and maintain a valid Driver License, current automobile insurance, and a driving record that meets the guidelines and requirements of the organization
Minimum of a High School Diploma or GED required
Must have one year of medical insurance verification or prior-authorizations related experience
Knowledge of insurance terms and reimbursement procedures
Excellent verbal and written communication skills required
Excellent telephone etiquette
Must have the ability to cooperate and collaborate as part of a team, taking action that indicates consideration for others
Must be able to apply common sense reasoning and decision-making to carry out detailed, involved billing transactions and to resolve problems involving several concrete variables
Must work assignments on time and readily accept assignments from supervisor
Must be able to adhere to strict confidentiality

Responsibilities

Coordinates prior-authorization for procedures, orders, or medications by verifying the correct authorization form, obtaining all necessary information to complete form, and submitting the form to the correct insurance plan.
Works with patients and insurance companies to secure retroactive insurance coverage and authorizations.
Tracks and follows up on all pending authorizations or requests for additional information depending upon payer guidelines to expedite the claim process.
Notifies appropriate staff of approved medical or medication authorizations and enters approved authorizations into the EHR.
Works closely with Utilization Review Coordinator, billing, providers, and clinical teams.
Knowledgeable in inpatient and outpatient coding, including and understanding of behavioral health, medical and psych procedures, ICD-10-CM, CPT, HCPCS, primary care, and residential.
Displays a courteous, professional, and positive demeanor with co-workers and others while performing essential duties.
Promotes effective working relations, both within the department and with other departments, to facilitate the department and organization’s ability to meet its goals and objectives.
Manages the end-to-end credentialing and recredentialing process for medical providers and clinically licensed therapists with Medicare, Medicaid, and commercial insurance payers.
Maintains accurate and up-to-date records, ensuring compliance with all payer requirements, regulatory standards, and accreditation bodies.
Coordinates and completes credentialing applications for Polara Health’s clinics and hospital facilities, including licensing, certifications, and insurance panel enrollments.
Serves as a liaison between providers, internal departments, and external agencies to resolve credentialing issues and ensure timely approvals.
Performs other duties as required.