Prior Authorization Specialist

Prior Authorization Specialist

Financial Services Building - Pascagoula / Full-Time / Monday - Friday 8:00am-4:30pm /
2809 Denny Avenue
Pascagoula, Mississippi, 39581
United States

Position Overview:
The Authorization Specialist evaluates medical services ordered for authorization requirements with payers and obtains authorization for diagnostic imaging, radiation therapy, oncology, rheumatology, and other services when necessary for reimbursement.

Expectation is for all performed duties to be in accordance with Singing River Health System procedures and policies, accreditation organization, and governing guidance and publications for health care employees.

DISCLAIMER: This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this intends to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks performed as assigned.

Education:
High School diploma or equivalent required. Associates or bachelor’s degree in business finance, healthcare administration, or related field preferred.

License:
N/A

Certifications:
Certification as a Prior Authorization Certified Specialist through the National Board of Prior Authorization Specialists preferred. 

Must have de-escalation training completed by the end of position orientation (90 days); must have appropriate level of de-escalation training.    

Experience:
Experience in a hospital or physician office setting obtaining authorizations for diagnostic imaging services or medical oncology services preferred.

Reports to:
Patient Access Services Manager

Supervises:
N/A

Physical Demands:
Work is moderately active: involves sitting with frequent requirements to move about the office, move about the facility, and to travel to another facility within the SRHS service area. Work involves exerting a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

Work involves using many physical motions in performing daily work activities; subject to exposure of body fluids, sputum and tissues, which may carry the hazard of infectious disease. Work involves using repetitive motions: substantial movements of the wrists, hands, and or fingers while operating standard office equipment such as computer keyboard.

Work involves being able to perceive the nature of sound at normal speaking levels with or without correction; the ability to make fine discriminations in sound. Work requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms/printed material that are closer to compare data at close vision.

Must be able to be active for extended periods of time without experiencing undue fatigue. Must be able to work schedules assigned with the understanding that changes may be instituted according to the needs of the hospital for off days, shifts or weekends.

Mental Demands:
Must demonstrate keen mental faculties/assessment and decision making abilities.  Must demonstrate superior communication/speaking/enunciation skills to receive and give information in person and by telephone.  Must demonstrate strong written and verbal communication skills.  Must possess emotional stability conducive to dealing with high stress levels.  Must demonstrate ability to work under pressure and meet deadlines.

Attention to detail and the ability to multi-task in complex situations is required.  Must have the ability to maintain collaborative and respectable working relationships throughout SRHS and other organizations.

Special Demands:
Must possess superior customer service skills and professional etiquette.  Must possess proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.), MS Outlook and Word.

Work requires the ability to function independently, adapt to workload demands, set priorities, and understand and set goals.  Must understand the fundamentals of automated data processing, and be able to quickly gain a detailed understanding of complex computerized and non-computerized information. 

Must possess knowledge of medical, coding, and billing terminology. Must have an understanding of Revenue Cycle functions in a hospital setting and thorough knowledge of state and federal laws, as they apply. Must be able to navigate within an Electronic Medical Record (EMR).