Prior Authorization & Verification Specialist

OVP Health Care•Huntington, WV

About The Position

Responsible for reviewing, submitting, monitoring, and responding to issues regarding medication prior authorizations. Reviews patient medical history to identify supporting documentation in the patient chart relevant to the medication. Professionally communicates with prescribers, practice support staff, patients, and representatives of insurance companies; includes oral and written communication. Responsible for contacting insurance companies via appropriate method to obtain prior authorization. Updates information in the patient medical record with approval or declination information; follows up with ordering physician as to status of prior authorization. Efficiently tracks pending authorizations for multiple offices/prescribers. Creates a positive, professional, service-oriented work environment for staff, patients, and family members by supporting the mission and values of OGG. Secondary Job Functions: Maintain confidentiality of patient and financial information by utilizing HIPPA guidelines and regulations. Responsible for reviewing, submitting, planning, and tracking of referrals made by clinic providers. Adheres to all Federal, State, and Local laws and regulations as well as policies.

Requirements

Knowledge of third-party payers and prior authorization requirements
Understanding of basic medical terminology and medications
Proficient use of office equipment, such as copier, fax machine, phones, etc.
Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical record systems.
Strong time management skills
Ability to work independently with minimal supervision
Ability to manage multiple priorities
High school diploma or equivalent

Nice To Haves

One (1) year of experience and relevant knowledge of insurance eligibility or prior authorization in a healthcare setting
Certified pharmacy technician, certified medical assistant, or licensed practical nurse

Responsibilities

Reviewing, submitting, monitoring, and responding to issues regarding medication prior authorizations.
Reviewing patient medical history to identify supporting documentation in the patient chart relevant to the medication.
Professionally communicating with prescribers, practice support staff, patients, and representatives of insurance companies.
Contacting insurance companies via appropriate method to obtain prior authorization.
Updating patient medical record with approval or declination information.
Following up with ordering physician as to status of prior authorization.
Efficiently tracking pending authorizations for multiple offices/prescribers.
Creating a positive, professional, service-oriented work environment for staff, patients, and family members by supporting the mission and values of OGG.
Maintaining confidentiality of patient and financial information by utilizing HIPPA guidelines and regulations.
Reviewing, submitting, planning, and tracking of referrals made by clinic providers.
Adhering to all Federal, State, and Local laws and regulations as well as policies.