Description

Job Summary: North Dallas Neurology Clinic is seeking an experienced Prior Authorization Representative that is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications for the clinic of 15 plus providers. Previous experience in a clinic and hospital setting is required.

Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data. Requires good judgment, tact, diplomacy, and ability to problem solve. Able to work effectively in a team environment. Able to use a personal computer and related software.

Duties/Responsibilities:

• Contact insurance carriers to verify patients’ insurance eligibility, benefits, and requirements.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Request, follow up and secure prior authorizations prior to services being performed. Send messages to staff and coordinate appointment scheduling once authorizations have been obtained.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Communicate any insurance changes or trends among team—stay up to date on insurance policies, regulations, and guidelines related to neurological medications and pre-auth processes.
• Meet with specialty pharmacy representatives and pharmaceutical company representatives.
• Request and obtain medical records to support the authorizations.
• Maintains a level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Import correspondence related to the authorization/authorization updates into the electronic medical record.
• Set up medication shipments.
• Abide by all HIPAA and confidentiality regulations and policies.
• Other duties as assigned.

Qualifications