Medical Prior Authorization Specialist

Job Description – Prior Authorization Specialist

Classification – FSLA - Non-Exempt - hourly

Salary Grade/Level/Range

Level of experience, longevity, within current company pay structure.

Reports to 

Revenue Cycle Manager

Summary/Objective 

Responsible for ensuring all pre-service accounts are financially cleared and secured prior to the date of service. The specialist is responsible for obtaining and verifying accurate insurance information, benefit validation, and authorizations. This is a key position that begins the overall patient experience and initiates the billing process for any services provided by the practice.

Essential Functions

• Contact insurance carriers utilizing telephone and/or payer websites to verify patient eligibility, benefits, authorization requirements. 
• Request, track and obtain pre-authorizations prior to services being performed. 
• Apply knowledge of medical terminology and general medical office procedures.
• Communicate any insurance coverage and/or authorization changes or trends among team. 
• Maintain level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format. 
• Screens visits for medical necessity and issues Advance Beneficiary or Non-Covered Service notices as appropriate.
• Provides cost estimates.

Qualities and Characteristics

• Maintains a professional relationship and positive attitude with co-workers, patients and all M.I.N.D staff.
• Strives to learn more and receptive to new challenges and opportunities.
• Displays enthusiasm toward the work and the mission of M.I.N.D. 

Qualifications

• High School Diploma or GED.
• Demonstrated knowledge of insurances
• 1 year experience in insurance verification, including navigating websites for online benefit review.
• Knowledge of CPT and ICD-10 codes.
• Excellent computer, multi-tasking and phone skills.
• The ability to work well under pressure to address time sensitive deadlines.
• Problem solving, time management and exceptional interpersonal skills.

Work Environment
This job operates in a medical office facility. 

Physical Demands

This position requires the ability to sit for long periods of time, view computer screens for long period of time, answer calls on a multi-line phone system, writing, reading and note taking.    

Position Type/Expected Hours of Work
This is a full-time position. Days and hours of work are Monday through Friday, varying hours between 8:00 a.m. to 4:30 p.m. 

• Travel – none

Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employees should adhere to all approved policies, procedures and philosophies.