Description:
The prior authorization specialist will assist patients who need treatment requiring insurance carrier pre-authorization. They interview patients to assess their medication needs and liaise with insurance companies and nurse managers for prior authorization approval.
Duties/Responsibilities:
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Accurately carries out the responsibility for verifying patient insurance coverage, and ensures that necessary visits and procedures are covered by an individual’s provider.
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Responsible for entering data in an accurate manner, updating patient benefit information and verifying that existing information is accurate.
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Demonstrates proficiency in working with insurance companies, and has extensive knowledge of different types of coverage and policies.
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Demonstrates excellent multitasking skills, with the ability to work on many projects at once. Is very detail-oriented and organized, and maintains accurate patient insurance records.
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Possesses the ability to focus and work quickly. Ensuring that paperwork is processed in a timely manner.
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Serves as a trusted resource to patients, providing them with pertinent information regarding their coverage.
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Uses good judgement in contacting the patient for discovered unforeseen issues (i.e. anticipated procedure not covered, large co-pay or co-insurance, patient’s insurance premium was not paid)
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Utilizes patient chart on an as needed basis, accessing only information related to treatment, payment, and health operations.
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Comply with HIPPA confidentiality standards when accessing or communicating patient information
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Other duties as assigned by supervisor, manager or physician
Requirements:
Required Skills/Abilities:
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Excellent verbal and written communication skills
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Ability to interact with patients and employees in a courteous, professional manner at all times
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Excellent organizational skills and attention to detail
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Ability to multi-task and function well in a high-paced and at times stressful environment
Education and Experience:
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High School Diploma or equivalent
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Healthcare receptionist experience preferred