Prior Authorization Specialist at Tanner Clinic

Kaysville, Utah, United States -

Full Time

Start Date

Immediate

Expiry Date

27 Apr, 26

Salary

0.0

Posted On

27 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Pre-Authorization, CPT Codes, HCPCS Codes, ICD-10 Codes, Medical Terminology, Communication Skills, Time Management, Organizational Skills, Problem-Solving Skills, Multi-Tasking, HIPAA Compliance, Patient-Focused Service, Office Equipment Operation, Insurance Knowledge, Conflict Resolution, Call Handling

Industry

Medical Practices

Description

Description Essential Job Responsibilities: Obtains pre-authorizations/pre-certification per payer requirements for services and ensures authorization information is documented appropriately. Verifies physician orders are complete, determines CPT, HCPCS and ICD-10 codes for proper authorization. Ability 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 patients in relationship to authorization status. Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes. Keep informed of changes in the authorization process and insurance policies Aid team members in maintaining turnaround times. Account for internal control responsibilities in line with the department objectives. Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA). Answer questions and offer other information, as requested, to provide patient-focused service and a positive impression of the organization. Other duties as assigned by the supervisor or manager. Requirements Education: High school diploma or equivalent Medical Assistant or higher Experience: 3-5 years of experience working in a hospital, doctor’s office, or pharmacy setting with knowledge of procedures and/or medication authorization experienced required. 1-2 years procedure and/or medication authorization experience preferred. Other Requirements: Regular and reliable attendance is an essential function of the job. Performance Requirements: Knowledge: Knowledge of CPT, HCPCS, and ICD-10 codes. Knowledge of medical terminology and departmental services. Skills: Basic computer skills (Microsoft Office Suite). Basic problem-solving skills. Possess pleasant and effective written, verbal, and telephone communication skills. Must possess excellent time management and organizational skills. Must possess multi-tasking skills. Abilities: Ability to maintain a professional demeanor during stressful situations. Ability to solve conflict. Ability to use multi-line phone system, including transferring calls and paging. Prevents, calms, or defuses irate callers and patients by working with them to identify concerns and properly directs calls. Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc. Work Environment: Position is in a well-lit office environment. Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.

Responsibilities

The Prior Authorization Specialist is responsible for obtaining pre-authorizations and ensuring proper documentation of authorization information. They maintain communication with providers and patients regarding authorization status and stay updated on insurance requirements.