Pre-Authorization specialist

Job Description:

The Pre-Authorization Specialist II is responsible for performing proficient benefit verification and pre-authorization functions with insurance carriers, within an established time frame, for new pre-surgical cases submitted to the Pre-Authorization Support Department.

Responsibilities will include:

Checking the departmental electronic inbox to coordinate the initial intake of physician and facility requests to secure prior authorization for service

Create electronic folders for new patients

Organize patient medical records in preparation for prior authorization and appeals process

Answers incoming calls received through the toll-free Pre-Authorization Support ACD and provides appropriate call/case handling

Performs benefit verification, pre-surgical authorization for new pre-surgical cases, and appeals by working closely with all payers

Utilizes proficient knowledge in Microsoft Office and database management to document case status, actions, and outcome

Communicates and builds relationships with HCP offices and Field Reimbursement Managers in regard to all inquiries for the handling of cases, i.e., missing case information, benefits, etc.

Utilizes customer service skills in engaging with customers, communicating with sales representatives, and working in teams in a call center environment to expedite processing of cases

Coordinates with lead and supervisor regarding complicated cases

Quality Systems Duties and Responsibilities:

Build Quality into all aspects of their work by maintaining compliance to all quality requirements.

Required qualifications:

High School Diploma

Minimum 2-3 years of recent Insurance Pre-Authorization experience. Must have recent experience!

Experience working with various payors including, Medicare, Medicaid, and Private Payor, as it relates to medical procedures, services, and devices

Experience building effective relationships with internal and external customers.