Prior Authorization Specialist I, Admissions, Full-Time

Qualifications –License, Education and/or Experience Required:

High school diploma or equivalent.

Knowledge of medical terminology preferred.

Essential Functions:

The specific requirements may vary due to the healthcare provider, insurance company, or complexity of the order. The primary goal of a pre-Authorization Specialist Is to work closely with healthcare providers, insurance companies, and patients to navigate the pre-authorization process, thereby ensuring that patients receive the necessary care and that providers are appropriately reimbursed.

This position completes the essential functions:

• Gather Patient Information: Collect and review patient medical records, diagnosis codes, and procedure details to support the pre-authorization request.

• Verify Insurance Coverage: Confirm patient information and insurance coverage through verifying photo ID, insurance cards, and personal information.

• Submit Pre-Authorization Requests: Prepare and submit pre-authorization requests to insurance companies, adhering to their specific procedures and requirements.

• Follow Up: Monitor the progress of pre-authorization requests and follow up with insurance providers to expedite the approval process.

• Communicate with Healthcare Providers: Collaborate with healthcare providers to obtain any necessary documentation, notes, or additional information required for pre-authorization.

• Patient Education: Explain the pre-authorization process to patients, including potential out-of-pocket costs, and address any questions or concerns they may have.

• Document and Recordkeeping: Maintain detailed records of pre-authorization requests, approvals, denials, and communications with insurance companies and healthcare providers.

• Compliance: Ensure that all pre-authorization processes comply with relevant laws and regulations, including HIPAA (Health Insurance Portability and Accountability Act).

• Appeals: If a pre-authorization request is denied, assist in the appeals process by providing necessary documentation and information to support the appeal

This position's hiring pay range is: $19.00-22.80 per hour, depending on education and experience.

Discretionary bonuses, relocation expenses, merit increases, market adjustments, recognition bonuses and other forms of discretionary compensation may be paid to eligible employees based upon organizational and individual performance.

Benefits:

Employees are eligible to participate in an attractive benefits package including medical, dental, vision, paid time off, education assistance, 403(b) with employer matching, and more. Eligibility is based on employment status. Details regarding specific benefit you may be eligible for will be discussed during the hiring process.

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Education

• High School or better

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)