Prior Authorization Specialist
Prior Authorization Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Cornerstone Family Healthcare is actively recruiting for a Prior Authorization Specialist to join our growing team.
RATE OF PAY/SALARY: $20.00 per hour
WORK LOCATION(S): Middletown NY
STATUS: FullTime
CORNERSTONE BENEFITS:
Competitive salaries I Health Benefits I Retirement plan I Paid Time Off I Sick Time I Flexible Spending I Dependent Care I Paid Holidays
CORNERSTONES MISSION:
Cornerstone Family Healthcare is a nonprofit Federally Qualified Health Center with a mission to provide high quality comprehensive primary and preventative health care services in an environment of caring dignity and respect to all people regardless of their ability to pay. For more than fifty years Cornerstone has been responsive to meeting the needs of the communities in which we serve with a continued emphasis on the underserved and those without access to health care regardless of race economic status age sex sexual orientation or disability.
- Assists patients in obtaining prior authorizations for treatment requiring insurance preauthorization.
- Handles all prior authorization submissions to proper insurances.
- Documents in EMR authorization status actions and outcomes.
- Communicates well with internal providers to obtain all the required information to submit prior authorization efficiently.
- Has medical terminology knowledge i.e. ICD CPT Procedure Codes/Names & Test Names.
- Responsible for notifying the appropriate internal departments of any information that they need to be aware of including complaints or adverse event notifications.
- Communicates and builds relationships with insurance carriers and servicing providers or facilities.
- Schedule peer to peer meeting between CFH provider and insurance company for prior authorization denials.
- Request and prepare supporting documentation for the medical necessity for the service being authorized examples include medical records labs previous prior authorization(s) appeals denials and prescriptions.
- Sorts daily work queues and is accountable to identify and process the daily work.
- Preforms initial insurance benefit verification and presurgical authorization for new OB/GYN or Podiatry surgical cases.
- Advises Provider and patients of any changes or cancellations of surgical/procedure bookings.
- Fields phone calls from staff and service providers and resolves inquiries related to prior authorizations.
- Easily manages multiple authorization requests at once.
- Exemplifies excellent customer service with patients visitors and other employees; shows courtesy friendliness helpfulness and respect.
- Consistently demonstrates respect for the capabilities different cultures and/or personalities of internal and external customers.
- Maintains and ensures patient privacy and confidentiality.
- Takes the initiative to proactively assist others
- Maintains open and effective communication with providers and employees to ensure quality patient care.
- Perform other related duties as assigned
- At least 12 years clerical experience in healthcare
- Knowledge of data entry
- Knowledge of medical terminology including ICD CPT Procedure Codes/Names & Test Names
- Pleasant telephone manner and ability to work under pressure
Required Experience:
Unclear Seniority
Employment Type
Full-Time
