Prior Authorization Specialist

JOB SUMMARY: This position will be requesting prior authorizations for services provided at MAHEC and services referred outside of MAHEC Service Lines.

SPECIFIC RESPONSIBILITIES:

• This position will be responsible for obtaining and requesting prior authorizations for the following: In-house procedures Medicare HMO visits radiology and behavioral health.
• This position will partner with the clinics and referrals team to acquire the necessary prior authorizations.
• This will include ensuring authorizations are approved and working on any denials that are received.
• This position will assist with any Peer-to-Peer requests and Appeals that are received.
• This position may also support other areas needing prior authorizations and referrals.

KEY COMPETENCIES:

• Communication Skills

Effectively and respectably communicate with other individuals whether it be a colleague patient or patients family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties especially in complex and difficult situations to ultimately provide the best care possible to our patients and their families.

• Decision Making

Ability to make the most appropriate decision in each situation and then take the next steps to ensure appropriate and timely completion. This requires conflict resolution skills critical thinking skills confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.

• HealthCare Knowledge

Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team as appropriate. This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHECs organizational training. Finally the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.

• Interpersonal Skills

Showing the ability to meet difficult situations with grace professionalism and understanding. Within your area of expertise showing respect and showing empathy where appropriate with your colleagues patients and their family at all times even when its most difficult to do so. This is done in part by effective listening being your authentic self showing responsibility and dependability and being patient with others.

• Organizational Values

Adherence to MAHECs founding principles and incorporating them every day. This includes among others having integrity and accountability reverence for other cultures and equitable practices ability to manage change and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need.

• Problem Solving

Having an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically through a difficult problem and come to an appropriate resolution for a given issue. This helps to drive continuous improvement by thinking through where we can improve in a novel way. Measures success by understanding where we are currently and where we want to go and then applying those new ideas to affect positive change.

SPECIFIED SKILLS

• Computer Basic typing Microsoft Office Suite (Outlook Excel Word PPT) Data Entry Required. Allscripts EHR experience preferred.

• Foreign Language

Fluency in Spanish a plus.

PHYSICAL DEMANDS

Typical fast-paced office environment with computers monitors printers email patient and provider messages in EHR system phone calls. Sitting for prolonged periods of time.

SUPERVISORY RESPONSIBILITIES:

• Not Applicable.

EDUCATION AND EXPERIENCE

MINIMUM QUALIFICATIONS:

• Some college and/or equivalent experience in the healthcare field such as Prior Authorization Experience experience in Human Services or Healthcare Administration with a focus on Utilization Review.

PREFERRED QUALIFICATIONS:

• Previous experience in prior authorizations is preferred

SCHEDULE:

• Regular attendance on-site is an essential function of this position. Typical business hours are Monday Friday 8:00 am to 5:00 pm (or flexed to best meet the needs of the clients and/or the Division); 40 hours per workweek; weekend holiday or evening coverage is occasionally required. Work hours will need to be flexible to respond to special work assignments or evening activities as requested by the team leader.

At MAHEC we strive to equip all team members with Total Rewards (pay benefits) to honor their service support their health manage their financial security build their career and thrive.

MAHEC is a qualifying employer for the Public Service Loan Forgiveness (PSLF) Program. Employees who meet federal requirements may be eligible to have remaining student loan balances forgiven after 10 years of qualifying payments while working full-time at MAHEC.

If you are interested in this role and you have related experience and qualifications we encourage you to apply or reach out to for support in your job search process. You could be the talent we are seeking for this or other opportunities

All MAHEC employees and learners will be required to receive the Flu vaccine or have an approved exemption.

MAHEC does not provide employment-based US visa sponsorship now or in the future. All new employees must provide valid original I-9 documents on their first day of work.

MAHEC Talent Management is located at 121 Hendersonville Road Asheville NC 28803. Equal Opportunity Employer.