Prior Authorization Specialist
About The Position
The Prior Authorization Specialist is responsible for obtaining prior authorization for provider practices which may include outpatient services, specialty care and other ancillary services. The Prior Authorization Specialist verifies insurance coverage and gathers clinical information to ensure that all reimbursement requirements are met. The ability to Compassionately engage in conversation with patients on their responsibilities for Copayment, Prepayment and Outstanding Balances. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Follows payer processes (website, fax, contact number) to submit appropriate clinical documentation; remains current on updates from payers to ensure appropriate reimbursement from payers. Serves as primary resource to ambulatory clinics regarding the prior authorization process and requirements. Collects clinical information regarding services to be rendered for prior authorizations. Contacts payers to obtain prior authorizations; enters standardized documentation within electronic medical record, to identify prior authorization and the criteria surrounding each authorization. Educates providers and their clinical staff regarding the prior authorization process; advises providers and their clinical staff when issues arise relating to obtaining prior authorization. Primary resource to patients regarding prior authorization process. Verifies that all insurance requirements have been met.
Requirements
- High School Diploma/GED
- 1 year Prior Authorizations and Revenue Cycle
Responsibilities
- Follows payer processes (website, fax, contact number) to submit appropriate clinical documentation; remains current on updates from payers to ensure appropriate reimbursement from payers.
- Serves as primary resource to ambulatory clinics regarding the prior authorization process and requirements.
- Collects clinical information regarding services to be rendered for prior authorizations.
- Contacts payers to obtain prior authorizations; enters standardized documentation within electronic medical record, to identify prior authorization and the criteria surrounding each authorization.
- Educates providers and their clinical staff regarding the prior authorization process; advises providers and their clinical staff when issues arise relating to obtaining prior authorization.
- Primary resource to patients regarding prior authorization process.
- Verifies that all insurance requirements have been met.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
