What are the responsibilities and job description for the Prior Authorization and Follow-Up Specialist position at Absentee Shawnee Tribe of Indians of Oklahoma?
This position is currently open.
Public?:
Public
Division:
Health
Reports To:
Business Office Manager
Type of Position:
Regular Full Time
Location:
Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
General Description
This position is located at the Absentee Shawnee Tribal Clinic- Little Axe Clinic in Norman, Oklahoma. The Clinics are an outpatient multi-disciplinary clinic established and managed by the Absentee Shawnee Tribe of Oklahoma. The Medical Coder plays a vital role in supporting accurate billing and efficient clinical operations within the health clinic. This position is responsible for securing timely insurance approvals for medical services and procedures by verifying coverage and submitting required documentation. The Prior Authorization and Follow Up Specialist tracks outstanding requests, follow up with payers, and ensure patients receive necessary care without delays or denials. Attendance is essential to achieving success in this role. Consistently showing up reflects reliability, dedication, and a readiness to meet the responsibilities and expectations required for effective performance. Employees are expected to carry out their duties with focus, contribute to a collaborative and respectful environment, and avoid actions that may disrupt team dynamics or productivity. Upholding professionalism and cultivating a positive and cooperative atmosphere are fundamental to excelling in this position.
Responsibilities & Duties
Coordination of resources, including primary and secondary third party payers.
Obtain precertification, referrals, and prior authorization of required medical services from third party payers.
Maintain a professional and confidential working environment.
Explain insurance benefits, policy requirements, and filing rules to patients.
Research and apply knowledge of all insurance rules and regulations for major insurance programs in the local or regional area.
Enter patient data into appropriate database and update and maintain accurate files.
Ensure client confidentiality and compliance with HIPAA regulations.
Determine the protocol that identifies a responsible party’s monetary responsibility in health insurance claims.
Confirm patient insurance details and coverage, following up authorization requests, tracking the progress of each authorization, and keeping detailed record of all communications.
Investigate insurance denials, analyze why an authorization was denied, identify root cause, and initiate appeals when necessary to ensure patient receives the care they require.
Maintain accurate and organized records of prior authorizations, including approvals, denials, and follow-up actions.
Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to insure a professional, responsible and courteous environment.
Safeguard confidentiality of the medical charts/electronic health records and complies with all local, state, and federal laws pertaining to medical records.
Assure compliance with all HIPAA regulations concerning use, retrieval, storage, and sharing of billing statements and medical records.
Perform other related duties as assigned.
Education Requirements and Qualifications
Education and Qualifications
High School Diploma or GED.
Three years of medical office experience.
Experience in required documentation for ICD-10-CM/DRG coding.
EHR and practice management systems experience required.
Experience in working with third-party resources such as Medicare, Medicaid and Private Insurance, Contract Health or Coordination of Benefits, medical records, reception and patient registration a must.
Knowledge of billing procedures and insurance verification.
Knowledge of medical terminology and medical insurance claims processing.
Knowledge of medical software is a must to access and interpret patient data.
Knowledge, Skills, Abilities
Must be computer literate.
Must possess the ability to communicate effectively verbally and written.
Must be self-motivated and have the ability to prioritize work tasks with good organizational skills.
Must have excellent customer service skills.
Strong attention to detail.
Must possess strong problem solving skills.
Must have a valid Oklahoma Driver’s License.
Must be able to pass a background check and drug test.
Physical Requirements and Working Conditions
Must be able to sit, stand, stoop, bend or kneel for long periods of time.
Prolonged sitting, standing, or walking; occasional bending, squatting, kneeling, and stooping; good finger dexterity and sensory perception; frequent repetitive motions; as well as talking, hearing, and visual acuity are required.
Frequent lifting (up to 15 lbs)
Occasional lifting (up to 30 lbs)
The Absentee Shawnee Tribe of Oklahoma (AST) is committed to Equal Employment without regard to race, religion, color, gender, national origin, age, disability, or sexual orientation. However, in accordance with the Indian Preference Act (Title 25 U.S. Code 472 and 473) preference in filling vacancies are given to qualified Indian candidates. AST will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and its amendments.
Native American Preference/EEO/Drug Free/Smoke Free Workplace
Posted Date:
1 day 53 min ago
Tribal Preference/Native American Preference/EEO/Smoke Free/Drug Free Workplace
Indian preference applies to all positions, but all resumes will be accepted.
Forward Completed Absentee Shawnee Tribe applications with resume to:
Absentee Shawnee Tribe
Human Resources Department
2025 South Gordon Cooper Dr.
Shawnee, OK 74801
Fax: 405-273-2710
Email: HR@astribe.com
