Specialist, Pre-Authorization – Full Time, #49263


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Posted Date: December 3rd, 2018

Job Description:

The Prior Authorization Specialist is responsible for verifying health insurance, obtaining benefits and meeting payer requirements to secure prior authorizations prior to scheduled procedures.

Verifies insurance coverage, resolves any issues with authorization, and escalates complicated issues to the appropriate manager. Acts as a liaison between patients, their health insurance, care providers to assist in understanding their healthcare financial responsibilities.

Works to establish timely, correct insurance prior to the patients procedure in order to financially secure the prior authorization, promote good customer service, efficient and accurate billing and promote reimbursement.

Assists with appealing denials from payers by submitting medical records and other supporting documentation as needed to secure authorizations or retro authorizations. Stays current with changes in insurances as it relates to prior authorizations and coverage’s for procedures.

High School or equivalent education.

Advanced education preferred or minimum 3+ years experience in health care. Requires a high level of detail and organization skills. Medical terminology preferred.

Strong verbal and written communication, listening and telephone /IM etiquette skills, knowledge of insurance plans desirable, accurate key boarding skills, ability to promote and maintain good patient relations and patient confidentially, knowledge of coding used by payers.

Basic computer skills. Proficient with spreadsheet, word processing and presentation software.

Ability to multi-task and tight timelines to maintain multiple priorities. Must be skilled at working independently and without daily direction.

Excellent customer service skills.

Education/Experience:

High School or equivalent education. Advanced education preferred or minimum 3 years’ experience in health care.

Requires a high level of detail and organization skills. Medical terminology preferred. Special Knowledge/Skills/Certifications/Licenses:

1. Strong verbal and written communication, listening and telephone /IM etiquette skills, knowledge of insurance plans desirable, accurate key boarding skills, ability to promote and maintain good patient relations and patient confidentially.

2. Knowledge of coding used by payers

3. Basic computer skills preferred.

4. Proficient with spreadsheet, word processing and presentation software

5. Ability to multi-task and tight timelines to maintain multiple priorities

6. Must be skilled at working

independently and without daily direction.

7. Excellent customer service skills

Union Name: Non-Union

Job Code: P5TF

Department: Patient Financial Services

Job Number: 49263

Status: Full-Time

Work Schedule: 80 hours per payperiod

Site: TRIA Physical Therapy and Ed Center, Bloomington

Hours/Pay Period: 80

Benefit Eligible: Yes