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· Answers incoming calls from clients (patients, physicians, insurance companies, etc.) as they relate to inquiries regarding insurance verification, out of pocket expenses, and authorizations.
· Performs outbound calling to physicians, insurance companies, pharmacists, and others clients to follow up on insurance verification and authorizations
· Update insurance verification forms when needed
· Call on any and all insurance companies to verify if authorization is needed and if so, record all and any pertinent information and obtain reference numbers with date and time called.
· Update applicable databases with insurance coverage verified benefits, including coverage effective dates, patient demographic information, emergency contacts, residence addresses, insured relationship if patient is not insured, and any other applicable information required by insurance and program in use.
· Verify all and prepare all appropriate authorization/ gap exception forms
· Adhere to all policies and procedures, with the most stringent attention to complying with all governmental and HIPAA mandated patient confidentiality regulations.
· Identify any issues or problems with payers and the possible difficulties in presenting clean claims to them based upon verification requirements
· Appropriately prioritize all prior authorization requests
· Continuing to keep all choices in regards to the patient’s medical history and patient status up to the provider’s discretion.
· Track and follow up on all pending authorization requests, including obtaining pertinent information required by insurance company and notifying patient/facility when approved.
· Verify provider is in network for each injection and if not, does patient have OON benefits
· Meet and discuss with staff and medical providers for clarification on authorization requests and on the status of authorization
· Call patients and cancel appointments if insurance has denied any procedures, imaging, or prescriptions
· Complete ASC packets and provide the correct documentation to ASC for scheduled patients
· Respond and cooperate with outside billing and prior authorization staff
· Serve and protect the physician or healthcare provider practice by adhering to professional standards, policies and procedures, federal, state and local requirements and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards
· Maintain safe, secure and healthy work environment by establishing and following standards and procedures and complying with legal regulations
Job Type: Full-time
Job Type: Full-time
Pay: $17.00 - $19.00 per hour
Benefits:
Weekly day range:
Education:
Experience:
Work Location: In person
Full Time
Business Services
$34k-42k (estimate)
01/17/2023
07/31/2024
summitpainfw.com
FORT WAYNE, IN
25 - 50
2013
MATT CABASINI
$5M - $10M
Business Services
The job skills required for Prior Authorization Specialist include Prior Authorization, Billing, HIPAA, Confidentiality, Health Insurance, Medical Billing, etc. Having related job skills and expertise will give you an advantage when applying to be a Prior Authorization Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Prior Authorization Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Prior Authorization Specialist positions, which can be used as a reference in future career path planning. As a Prior Authorization Specialist, it can be promoted into senior positions as an Admitting Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Prior Authorization Specialist. You can explore the career advancement for a Prior Authorization Specialist below and select your interested title to get hiring information.
If you are interested in becoming a Prior Authorization Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Prior Authorization Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Prior Authorization Specialist job description and responsibilities
Request, follow up and secure prior-authorizations prior to services being performed.
04/09/2022: Laramie, WY
Receive requests for pre-authorizations and ensure that they are properly and closely monitored.
03/28/2022: Schenectady, NY
Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
02/27/2022: Wichita, KS
Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
04/08/2022: Altus, OK
Reported to supervisor to assure accurate capture of services needing authorization.
02/05/2022: Dothan, AL
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Prior Authorization Specialist jobs
Prior Authorization Specialist must have excellent computer skills including Excel, Word, and Internet use.
02/12/2022: New Britain, CT
A good Prior Authorization Specialist are those who are detail oriented with above average organizational skills.
03/28/2022: Galveston, TX
Basic understanding of human anatomy, specifically musculoskeletal would also give you benefits for this role.
04/04/2022: Lebanon, PA
Some experience in medical billing or insurance authorization are strongly preferred by most employers.
03/10/2022: Jamestown, NY
Licenses and certifications are not usually required to work as a prior authorization specialist.
04/02/2022: Mcallen, TX
Step 3: View the best colleges and universities for Prior Authorization Specialist.