Prior Authorization Specialist
Prior Authorization Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
Keystone Advisors is looking for a Prior Authorization Specialist to join our team in Matteson IL supporting one of our healthcare clients.
Job Summary
The Prior Authorization Specialist is responsible for obtaining and processing all prior authorization requests coordinating phone calls entering and tracking data from insurance providers and health plans regarding authorization expedited reviews and appeals. The Prior Authorization Specialist is required to document and track all communication attempts with insurance providers and health plans follow up on all denials while working to ensure services are validated.
Typical Duties
- Reviews accounts and initiate preauthorizations and other requirements related to managed care; route to appropriate departments as needed.
- Collects demographic insurance and clinical information to ensure that all reimbursement requirements are met.
- Notifies the necessary parties within the required timeframe for routine and urgent requests for services.
- Assists in monitoring utilization services to assure cost effective use of medical resources through processing prior authorizations.
- Communicates with patients and/or referring physicians on noncovered benefits or procedure coverage issues.
- Assists with medical necessity documentation to expedite approvals and ensure that appropriate followup is performed.
- Provides consistent and comprehensive information (both in writing and verbally) to facilitate approvals.
- Ensures insurance carrier documentation requirements are met and authorization documentation is entered and recorded in the patients records.
- Appeals preauthorization denials and/or setup peer to peer reviews.
- Maintains an extensive working knowledge and expertise of insurance companies and billing authorization requirements.
- Identifies and reports undesirable trends and re
- imbursement modeling errors or underlying causes of incorrect payment; review allowed variances from third party payers.
- Builds and maintains working relationships with staff referral sources insurance companies and medical providers.
Minimum Qualifications
- High School diploma or GED equivalent with five (5) years of prior authorization experience OR Bachelors degree with two (2) years of prior authorization experience
- Three (3) years of experience processing insurance requests to obtain prior authorization
- Experience and familiarity with using insurance portals i.e. Anthem Availty Evicor Covermymeds Magellang
Preferred Qualifications
- Knowledge and experience with payer processes to submit appropriate clinical documentation
- Experience using Medical Terminology
Knowledge Skills Abilities and Other Characteristics
- Proficiency with Microsoft applications and internetbased programs
- Strong interpersonal skills with the ability to establish strong working relationships
- Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
- Strong time management skills to prioritize assignments and meet the designated deadline
- Ability to anticipate recognize and meet the needs of the patients and their families
- Ability to work in a teambased environment to accomplish goals and objectives
- Ability to demonstrate respect and sensitivity for cultural diversity in clients work force and patient population
- Ability to critically think problem solve and make independent decisions supporting the authorization process including interactions with payer representatives physicians and hospital case managers
Compensation Package:
- Competitive Salary
- Paid Time Off
- Health Vision & Dental Insurance
- Health Savings Account (HSA)
- Flexible Spending Account (FSA)
- Short & Long Term Disability
- 401 (K) with company match
- Life Insurance
Required Experience:
Junior IC
Employment Type
Full-Time
