Prior Authorization Specialist (TPS)

QUALIFICATIONS:

High School diploma or GED with Two Years of College or Professional School preferred Two years of experience working in the medical field Familiarity with Electronic Medical Record required Knowledge of online resources to obtain prior-authorizations One year experience with ICD-9 and current with ICD-10, CPT codes. Demonstrates overall knowledge of managed care plans Comprehensive working knowledge of third party insurance processes required Intermediate to expert knowledge and computer skills including Windows programs and database applications preferred. Includes good keyboard skills 45 wpm with high accuracy rate Understanding of insurance payor reimbursement, authorization, practice management systems follow-up helpful Ability to prioritize tasks, work independently, and in a close environment with peers Strong leadership skills with attention to detail and accuracy Ability to communicate effectively

JOB SUMMARY:

The Prior Authorization Specialist ensures necessary approvals obtained from insurance providers before medical procedures or services are rendered. Responsibilities include: Verifying patient illegibility, reviewing medical documentation, communicating with healthcare providers & insurance companies to facilitate the authorization process. Strong attention to detail & knowledge of insurance policies & procedures are essential to this role.

Position Responsibilities/Duties:

Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements. Request, track and obtain prior-authorization from insurance carriers within time allotted for outpatient imaging, surgery and lab services Request, follow up and secure prior-authorizations prior to services being performed Works in collaboration with medical sites to obtain any additional clinical documentation that can be forwarded to insurance carrier Provides direct support to primary care practices and specialty care providers regarding utilization, authorization, and referral activities Proficient in the use of ICD-9 and CPT codes. (ICD-10 preferred) Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations Communicate any insurance changes or trends among team Maintains a level of productivity suitable for the department Clearly document all communications and contacts with providers Maintaining accurate & organized records of authorization requests, approvals & denials Full Time Days