Prior Authorization Specialist

Seeks to verify correct insurance prior to the patient's procedure/medication fulfillment in order establish financial grounds for efficient billing and prompt reimbursement and to promote good customer service with patients.

• Utilizes Practice Management System's real time eligibility or insurance websites to verify insurance.
• If needed, contacts patient or referring clinic to obtain correct information and enters into patient chart.
• Participate in practice improvements by implementing changes to procedures/workflows, identifying opportunities for improvement, and assisting with the delivery of compassionate and personalized patient care.

Secures prior authorization for neurodiagnostic tests, procedures, prescriptions, as required.

• Utilizes insurance company websites to verify the need for a prior authorization and subsequently obtain prior authorization for services and/or prescriptions. Calls insurance company by phone, as needed.
• Communicate with Patient Care Coordinators and other team members to obtain clarification and information related to a patient's medication and/or procedure status. Keeps Patient Care Coordinators informed of status.
• Populates authorization documentation in electronic health record as required. Scans/faxes/uploads appropriate documents to insurance companies as required.
• Stays on top of changes/updates from insurance companies regarding prior authorization requirements.
• Escalates complex issues to the appropriate manager/supervisor for resolution.

Education and Experience:

• High school graduate or GED; business school/college courses desirable.
• Minimum of one year experience in a medical office setting including working with insurance/billing.
• Must have working knowledge of medical terminology and authorization requirements for insurance payors.

Knowledge, Skills, and Abilities:

• Patient centered, strong customer service orientation.
• Ability to handle multiple priorities and deadlines and troubleshoot and resolve problems.
• Ability to work independently, exhibit mature judgment and make sound decisions.
• Knowledge of medical terminology, insurance, and knowledge and understanding of third-party payment and coding guidelines, rules, and regulations.
• Handle confidential information with the utmost judgment and discretion.
• Ability to coordinate duties with peers; good human relations skills.
• Promptly and responsibly answer general questions/handle problems relating to all major areas and responsibility.
• Proficiency with MS Office, including Word, Excel and Outlook