Prior Authorization Specialist
Prior Authorization Specialist
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Job Description
Job Details
Description
US Heart and Vascular is in need of a Remote Cardiology Prior Authorizations Specialist.
If you have a passion for obtaining prior authorizations for Veins Structural Heart and CT Studies please join our US Heart and Vascular team
Responsibilities
Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
Responsible for verification and investigation of pre-certification authorization and referral requirements for services.
Coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits.
Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
Communicates with patients clinical partners financial counselors and others as necessary to facilitate the authorization process.
Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
Completes accurate documentation in all applications.
Follows departmental policies and procedures when necessary authorization is not obtained before the service date.
Answers provider staff and patient questions surrounding insurance authorization requirements.
Handles escalated authorization requests as needed.
Provides team mentorship as needed.
Works other departmental tasks as needed.
Requirements
Familiarity with medical office procedures and billing practices
Proficient in clinical documentation review for alignment with insurance authorization requirements
Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include but are not limited to: OSHA HIPAA Federal Fraud and Abuse laws.
High School Diploma or equivalent required
Associates degree in healthcare administration or business administration preferred
A minimum of 3-5 years experience in the same role or related field in a healthcare setting is required.
ECWexperience is preferred.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
