Prior Authorization Specialist

Essential Job Functions: Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented appropriately in the system. Verifies physician orders are accurate, determines CPT, HCPCS and ICD-10 codes for proper Prior to understand and communicate insurance co-pays, deductibles, co-insurances, and out-of-pocket expenses for point of service collections. Communication is maintained with providers, clinical staff, and patient in relationship to authorization and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested. Helps to maintain a professional atmosphere for patients, family members and staff. Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes. Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding. Ability to demonstrate good customer service (AIDET) Aid team members in maintaining turnaround times as expected from client Account for internal control responsibilities in line with the organization#s objectives Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA) Other duties as assigned by supervisor or manager Answer questions and offer other information, as requested, to provide patient-focused service and a positive impression of the organization Suggests improvements and participates in organized efforts to improve service levels

Position Qualifications: Education / Experience / License and Certifications:

• High school graduate or equivalent. Knowledge of CPT, HCPCS, and ICD-10 codes preferred. Medical terminology required.3-5 years of experience working in a hospital, doctor#s office, or billing setting
• Have working knowledge of CPT codes and Diagnostic Codes 1-2 years procedure and/or medication authorization experience required.
• Additional Skills:
• Ability to effectively present information and respond to questions from providers, clinical staff, payors, and