Prior Authorization Specialist

West Michigan Dermatology • Grandville, MI

2d • Onsite

About The Position

The Prior Authorization (PA) Specialist works to obtain approval from insurance companies for procedures, treatments and medications for West Michigan Dermatology patients. This includes initiating the PA process and following it through till approval is obtained – submitting appeals when needed.

Requirements

• 3+ years of experience in a medical office working with insurance and authorization processes.
• Knowledge of medical terminology, ICD10 codes, and HIPAA regulations.
• Skilled in using various computer programs and applications especially word processing and EMR.
• Meticulous documentation skills in addition to a high level of attention to detail.
• Ability to multi task and work efficiently under pressure.
• Must be computer literate with the ability to work with various computer systems such as EMR, word-processing and project management programs.
• Ability to communicate clearly and concisely using excellent grammar and punctuation in all written correspondence.
• Ability to establish and maintain positive relationships with employees, physicians, and management.

Responsibilities

• Collects patient demographic and insurance information verifying that reimbursement criteria are present.
• Navigates complexities with insurance companies and pharmacies in order to obtain prior authorizations in a timely fashion. Appeals these decisions if needed.
• Keeps up with drug manufacturer recommendations, formulary changes, claim denials, and any other relevant information specific to biologic medications maintained on site.
• Utilizes EMR to update patient record meticulously with the status of the PA.
• Possesses a strong knowledge base with regard to insurance requirements as well as billing authorization requirements.
• Is able to provide patient education and communication on the status of their PA that is detailed and accurate.
• Remains current on the latest developments with insurance coverage and denials.
• Other duties as directed by the site manager and providers.

Benefits

• Competitive compensation
• Health dental, vision benefits for full time employees
• Retirement package
• PTO accrual and holiday benefits
• Employee discounts on products and services
• An environment that encourages employees to be high performance and to grow within the organization.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 101-250 employees