What are the responsibilities and job description for the RCM Prior Authorization Specialist position at SLOCUM ORTHOPEDICS, P.C.?

· Submits, tracks, and manages prior authorization requests for medical and ancillary procedures, within strict timeframes.
Researches and resolves authorization and referral claim denials, while coordinating with physicians, providers, and insurance payers to file appeals or facilitate a P2P.
Reviews patient medical records and clinical documentation to ensure they meet payer coverage criteria.
Collaborate with the RCM Prior Authorization Supervisor and Team Lead to develop and update authorization policies and procedures.
Maintain knowledge of payer guidelines (Medicare, Medicaid, Commercial, etc.) and ensuring regulatory compliance.
Partner with the RCM Prior Authorization Supervisor and Team Lead to analyze denied claims resulting from prior authorization and referral errors by identifying the root cause and provide the corrected data to the billing team for the purpose of appealing or resubmitting a corrected claim.
Interacts with insurance payers, physicians, providers, and Slocum departments to clarify coverage requirements to expedite approvals.
Work in collaboration with the RCM Prior Authorization Supervisor and Team Lead to monitor prior authorization related utilization trends, claim denials, denial rates, and provide performance improvement suggestions to senior leadership.
Communicate cross-functionally with providers and other Slocum departments regarding patient questions or referral and authorization concerns.
Perform other duties as assigned.

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RCM Prior Authorization Specialist