What are the responsibilities and job description for the Prior Authorization and Scheduling Representative position at Trinity Employment Specialists?
Prior Authorization and Scheduling Representative (onsite position, not remote)
Location: Tulsa, OK
Schedule: Monday - Friday, 8:00 AM - 5:00 PM
Compensation: Based on Experience ($17.00 - $19 per hour)
Position Overview:
We are seeking a detail-oriented and motivated Prior Authorization and Scheduling Representative to join our team in Tulsa, OK. This role is essential in coordinating patient services by managing prior authorizations and scheduling specialized studies. The ideal candidate will have strong analytical skills, attention to detail, and a solid understanding of healthcare authorizations, pre-certification, and scheduling processes.
Key Responsibilities:
Obtain Prior Authorizations: Secure necessary authorizations for special studies from various insurance carriers using carrier-specific tools and systems.
Maintain Pre-Certification Knowledge: Keep current with each payer's pre-certification requirements, leveraging payer-specific websites and resources.
Clinical Data Analysis: Evaluate and interpret clinical data in relation to authorization requests, cross-referencing medical terms, diagnoses, and CPT codes to ensure compliance with insurance requirements.
Eligibility & Benefits Verification: Confirm eligibility and benefits for each special study request, ensuring accurate and compliant processing.
Scheduling Coordination: Arrange appointments for authorized special studies, coordinating with patients and clinical teams to ensure optimal scheduling and resource utilization.
Documentation: Accurately enter and maintain detailed notes in the practice management system regarding referrals, authorizations, special studies, and scheduling.
Qualifications:
Familiarity with medical terminology, CPT codes, healthcare authorization, and scheduling processes
Strong analytical, organizational, and data management skills
Proficiency in using payer-specific websites, tools, and scheduling software
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* Determine eligibility of persons applying to receive assistance from government programs and agency resources, such as welfare, unemployment benefits, social security, and public housing.
* Interpret and explain information such as eligibility requirements, application details, payment methods, and applicants' legal rights.
* Keep records of assigned cases, and prepare required reports.
* Interview benefits recipients at specified intervals to certify their eligibility for continuing benefits.
* Compile, record, and evaluate personal and financial data to verify completeness and accuracy, and to determine eligibility status.
* Answer applicants' questions about benefits and claim procedures.
* Compute and authorize amounts of assistance for programs, such as grants, monetary payments, and food stamps.
* Provide social workers with pertinent information gathered during applicant interviews.
* Provide applicants with assistance in completing application forms, such as those for job referrals or unemployment compensation claims.
* Prepare applications and forms for applicants for such purposes as school enrollment, employment, and medical services.
* Monitor the payments of benefits throughout the duration of a claim.
* Refer applicants to job openings or to interviews with other staff, in accordance with administrative guidelines or office procedures.
* Schedule benefits claimants for adjudication interviews to address questions of eligibility.
* Check with employers or other references to verify answers and obtain further information.
* Initiate procedures to grant, modify, deny, or terminate assistance, or refer applicants to other agencies for assistance.