Prior Authorization Specialist

Job Title: Prior Authorizations Specialist Job Summary: The prior authorization specialist will assist patients who need treatment requiring insurance carrier pre-authorization. They interview patients to assess their medication needs and liaise with insurance companies and nurse managers for prior authorization approval.

Duties/Responsibilities: Accurately carries out the responsibility for verifying patient insurance coverage, and ensures that necessary visits and procedures are covered by an individual’s provider. Responsible for entering data in an accurate manner, updating patient benefit information and verifying that existing information is accurate.

Demonstrates proficiency in working with insurance companies, and has extensive knowledge of different types of coverage and policies. Demonstrates excellent multitasking skills, with the ability to work on many projects at once. Is very detail-oriented and organized, and maintains accurate patient insurance records. Possesses the ability to focus and work quickly.

Ensuring that paperwork is processed in a timely manner. Serves as a trusted resource to patients, providing them with pertinent information regarding their coverage. Uses good judgement in contacting the patient for discovered unforeseen issues (i.e. anticipated procedure not covered, large co-pay or co-insurance, patient’s insurance premium was not paid) Utilizes patient chart on an as needed basis, accessing only information related to treatment, payment, and health operations.

Comply with HIPPA confidentiality standards when accessing or communicating patient information Other duties as assigned by supervisor, manager or physician Required Skills/Abilities: Excellent verbal and written communication skills Ability to interact with patients and employees in a courteous, professional manner at all times Excellent organizational skills and attention to detail Ability to multi-task and function well in a high-paced and at times stressful environment Education and Experience: High School Diploma or equivalent Healthcare receptionist experience preferred Physical Requirements: Prolonged periods of sitting at a desk, working on a computer Repetitive hand movements (specifically keyboarding and writing) Travel to other offices as needed