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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

  • 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
    • 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

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