Job Title : Prior Authorizations Specialist / Pre Certification

Location

Louisville, KY- 100% Onsite

Schedule

8 hour shift between the hours of 7am-6pm

Duration / Type

Contract (3-6 months)

Job Overview :

LHH Recruitment Solutions has partnered with a healthcare organization seeking a Prior Authorization Specialist. This position is based in Louisville, KY and requires 100% on-site presence.

Surgery or Imaging Authorization experience is required. This is a temporary position lasting 3-6 months.

Responsibilities :

• Review, evaluate, verify and process assigned clinic pre-certification requests for Inpatient, Outpatient and other clinic procedures performed by providers.
• Contact insurance companies for pre-certification, at least seven days prior to the patient's scheduled procedure.
• Apply basic coding knowledge and proficiency in medical terminology to translate orders to appropriate CPT and Diagnosis information required to provide to third party payers for prior authorization.
• Work with providers to coordinate peer-to-peer review with third party payers or find suitable alternatives to tests or procedures that do not meet prior authorization requirements.
• Work with third party payers to obtain all necessary information to complete a prior authorization, such as reviewing medical document for past procedures, therapies, tests or other clinical services.
• Enter all prior authorization information into the scheduling and billing system.
• Assist Clinics in obtaining prior authorizations for emergency admits and for patients needing same day clinic visit / hospital admit / procedure.
• Confirm all necessary information needed to properly perform and identify billing information needed to maintain compliance with institutional, state and federal practices.
• Verify patient eligibility and prior authorization requirements through On-line verification software or by telephone and follow up with third party payers within 0-48 hours of request.

Qualifications

• High school diploma or GED required; college preparation preferred.
• 1 experience in a healthcare prior authorization or insurance authorization role. - NO MEDICATION AUTHORIZATIONS, needs surgery or imaging

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan.

Our program provides employees with the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law;

any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Last updated : 2024-04-27