Prior Authorization Specialist

Cornerstone Family Healthcare•City of Middletown, NY

6h•Onsite

About The Position

Cornerstone Family Healthcare is actively recruiting for a Prior Authorization Specialist to join our growing team in Middletown, NY. This role is responsible for assisting patients in obtaining prior authorizations for treatment requiring insurance pre-authorization, handling all prior authorization submissions, and documenting authorization status in the EMR. The specialist will communicate with internal providers and insurance carriers, prepare supporting documentation for medical necessity, and manage daily work queues. Additionally, the role involves performing initial insurance benefit verification, advising on changes to surgical bookings, and resolving inquiries related to prior authorizations. The position requires excellent customer service, respect for diversity, and maintaining patient privacy and confidentiality.

Requirements

Bilingual (English & Spanish)
At least one-year clerical experience in a health-related field
Knowledge of data entry
Pleasant telephone manner

Responsibilities

Assists patients in obtaining prior authorizations for treatment requiring insurance pre-authorization.
Handles all prior authorization submissions to proper insurances.
Documents in EMR authorization status, actions, and outcomes.
Communicates well with internal providers to obtain all the required information to submit prior authorization efficiently.
Has medical terminology knowledge, i.e. ICD, CPT, Procedure Codes/Names, & Test Names.
Responsible for notifying the appropriate internal departments of any information that they need to be aware of, including complaints or adverse event notifications.
Communicates and builds relationships with insurance carriers and servicing providers or facilities.
Schedule peer to peer meeting between CFH provider and insurance company for prior authorization denials.
Request and prepare supporting documentation for the medical necessity for the service being authorized, examples include medical records, labs, previous prior authorization(s), appeals, denials and prescriptions.
Sorts daily work queues and is accountable to identify and process the daily work.
Preforms initial insurance benefit verification and pre-surgical authorization for new OB/GYN or Podiatry surgical cases.
Advises Provider and patients of any changes or cancellations of surgical/procedure bookings.
Fields phone calls from staff and service providers and resolves inquiries related to prior authorizations.
Easily manages multiple authorization requests at once.
Exemplifies excellent customer service with patients, visitors, and other employees; shows courtesy, friendliness, helpfulness, and respect.
Consistently demonstrates respect for the capabilities, different cultures and/or personalities of internal and external customers.
Maintains and ensures patient privacy and confidentiality.
Takes the initiative to proactively assist others.
Maintains open and effective communication with providers and employees to ensure quality.
Perform other related duties as assigned