Prior Authorizations Specialist- Cognitive and Memory Disorders

Hartford HealthCare•Wethersfield, CT

20h•Onsite

About The Position

Under the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain insurance prior authorizations for all in office procedures, medications, and any surgical services in a timely manner. Responsible for creating, maintaining and managing resources, including insurance portal access. Must have consistent documentation in EPIC to support the obtained insurance authorization. Will communicates changes in payer and or federal regulatory guidelines to their manager, providers and other clinical departments, as applicable.

Requirements

Experience and knowledge of insurances and prior authorizations
Ability to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companies
Must be self-motivated and have the ability to work independently and within a team
Demonstrates excellent telephone, computer, organization and customer service skills

Nice To Haves

High School Graduate/Diploma preferred
At least one year experience working with insurances and prior authorizations, preferred

Responsibilities

Monitors and reviews the prior authorization work queue daily to verify accuracy of patient’s insurance information and to interpret insurance pre-authorization requirements for scheduled procedure, surgery and or medication.
Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled date of procedure.
Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.
Immediately communicates to provider when a procedure, medication or surgery is denied by the insurance company. Assists in setting up peer to peer reviews
Collaborates and communicates with pharmacy regarding preferred drugs on the particular insurance plan and notifies providers of alternatives
Maintains log of missed prior authorizations and assists manager with timely retro authorizations or appeals to recoup revenue.
Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.
When time allows can help out in the office with managing incoming phone calls, baskets and other front desk coverage, answering phones and transcribing orders and referrals.
Monitoring referral work queue, registering arriving patients, answering incoming calls as well as other assigned duties as needed.