Position: Prior Authorization Specialist
Rate of Pay: $13.50-15/Hour
Employment Type: Full Time; Temp to Hire
Under the general supervision of the Prior Authorization Supervisor, this position is responsible for exercising independent judgment, to process “Provider service requests”, referrals and Prior authorizations administration. All Provider service requests, referrals and Prior authorizations will be processed according to the appropriate patient third party insurance guidelines. The position is responsible for both on and off site services.
Essential Duties and Responsibilities
- Completes prior authorizations and/or referrals for requested services to include but not limited appointments, outpatient procedures, diagnostic procedures and/or therapies.
- Reviews future appointments on a daily and weekly basis to verify that all required authorizations and/or referrals have been requested, paying close attention to short notice appointments.
- Receives and enters approved and/or denied requests for authorization/referral from third party insurance companies. Meets department goals for processing accuracy and turn around standards.
- Knowledge of third party insurance company’s prior authorization/referral requirements.
- Educates and answers questions for staff and offsite providers on third party insurance processes, phone numbers, patient insurance identification numbers, group numbers, individual policy and benefits.
- Verifies that CRS patients have the benefit and requests prior authorization if they do not.
- Obtains and transmits patients’ notes to third party insurance and PCP offices when requested to support a pending authorization/referral.
- Coordination with the scheduling department when authorizations/referrals have been approved for onsite services.
- Coordination with offsite physicians, hospitals other facilities and families when an authorization/referral has been approved for offsite services.
- Reviews patient information, diagnosis, CPT4 and ICD10 service codes with third party insurances to establish medical necessity for requested services.
- Assist the billing department when there are issues with authorizations/referrals.
EDUCATION AND EXPERIENCE:
- High School diploma or equivalent. At least two years in a related field and/or experience in a healthcare environment preferred. Experience working with 3rd party insurance companies preferred. To perform this job successfully, an individual must have thorough knowledge of AHCCCS, CRS, and third-party insurance prior authorization and referral guidelines. Experience in precertification, referrals and prior authorization is required. Responsible person should have a solid understanding of medical terminology and CPT4 as well as ICD9 coding practices
- Ability to read, analyzes, and interprets AHCCCS, CRS guidelines. Effectively presents information and respond to inquiries or complaints from employees, patients and/or their representatives, and the public. Fosters open communication between all functional areas of Clinic. Both oral and written communication must be clear and concise.
- Employees must be fingerprinted and undergo a criminal background check. Fingerprinting must be completed within 90 days of employment. Employees are required to have a current Department of Public Safety Level 1 Fingerprint Clearance Card.
To apply or learn more about this opportunity, please email your resume to firstname.lastname@example.org or call our office at 520-323-3100. Please reference Order ID: 4BZ5