Prior Authorization Specialist

Company: Rural Health Group, Inc.
Location: Roanoke Rapids
Posted on: May 26, 2023

Job Description:

Rural Health Group is seeking a full-time Prior Authorization Specialist at our RHG @ Halifax Medical Specialist office.
A prior authorization specialist is an individual who is highly skilled in ensuring that patients receive the medication and/or diagnostic services that requires pre-authorization from insurance carriers. These individuals address and rectify rejected claims and conduct necessary third party authorization requests.
Successful candidate must demonstrate the Rural Health Group Core Competencies, which include:

• Good Judgment
• Communication/Customer Service/Teamwork
• Passion
• Honesty
• Responsibility
• Job-Specific Skill Set
  ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
  
  

• Follow prior authorization work flow policies and procedures
• Collaborate with other departments to assist in obtaining prior authorizations.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present
• Receive requests for prior authorizations and ensure that they are properly and closely monitored.
• Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes
• Manage correspondence with insurance companies, clinicians and patients as required
• Document all prior authorization information including approval dates, prior authorization number in hospital system
• Proactively work on prior authorizations that are timely
• Secure patients' demographics and medical information by ensuring that all procedures are in sync with HIPAA compliance and regulation
• Advise providers and their clinical staff when issues arise relating to obtaining prior authorization
• Stay informed and research information regarding insurance criteria changes/updates for prior authorization
  REQUIREMENTS
  • High school diploma or GED.
  • 2+ years of related experience; prior- authorization experience highly desired
  • Knowledge of medical terminology - Understanding of insurance requirements for prior authorization
  • Experience in Radiology / Pharmacy / Laboratory Prior Authorizations
  • Understanding of CPT codes and vast knowledge of insurance required
  • Knowledge of eCW or other electronic health record preferred
  • Knowledge of Commercial Payors, Medicare & Medicaid desired
  • Excellent verbal, written, organizational and customer service skills
  • Ability to work independently, meet deadlines and be flexible
  • Ability to perform tasks accurately and efficiently when entering data electronically
  • Proficient typing/keyboarding skills
  • Basic knowledge of Microsoft Office, Excel and Outlook
  • Physical Demands: Must be able to sit for long periods of time. Must be able to lift 25-50 pounds. Must be able to ambulate for extended periods of time.
  • Embraces the team concept; encourages and models healthy, productive team behavior
  • Bilingual (English/Spanish) is a plus, but not required - applicants who may serve in a translating capacity will be required to take a language assessment
    EOE. Federal and State Criminal Background Checks and Drug Screen required for all positions. Influenza and COVID-19 vaccinations are a condition of employment.
    
    E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.

Keywords: Rural Health Group, Inc., Greenville , Prior Authorization Specialist, Other , Roanoke Rapids, North Carolina