Prior Authorization Specialist Job Listing at Thompson Health in Canandaigua, NY (Job ID 729d6587-2acf-4b5c-8ad5-5fe3d13e4d58)

Description

Schedule: Monday - Friday  8a-430p  Canandaigua Rehab Clinic

Job Competencies: 

• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Receive request for prior authorizations through the payer websites and/or via phone/fax and ensure they are properly and closely monitored.
• Prioritize incoming authorizations by level of urgency to the patient.
• Contact Insurance Carriers to verify patient's insurance eligibility, detailed benefits, and requirements for the service being ordered.
• Process referrals and submit medical requested medical documentation to insurance companies to expedite prior authorization processes: Obtain authorization via payer website or by phone and follow up regularly on pending cases. Enter current authorization information into the EMR
• Review accuracy and completeness of information requested and ensure that all supporting documents are present: Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow up is performed: review chart documentation to ensure patient meets medical policy guidelines and confirming accuracy of CPT and ICD-10 codes
• Manage correspondence with insurance companies, physicians, rehab providers, and patients as needed, including documenting in the EMR as appropriate. Respond to internal/external inquiries relating to authorizations. Clearly documents all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Maintains a level of productivity suitable for the department
• Demonstrates skill in daily communication including effectively gathering and disseminating information. Demonstrates flexibility in decision-making and prioritizing assignments.  Demonstrates skill on proactively resolving problems, recommending, and implementing continuous quality improvements.  Demonstrates the ability to develop and maintain collaborative working relationships with associates, physician practices and community members.

Qualifications: 

• Knowledge of procedure authorization and its direct impact on the rehab's revenue cycle
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Working knowledge of medical terminology and basic understanding of human anatomy, specifically musculoskeletal
• Proficient use of CPT and ICD-10 codes and registration
• Excellent computer skills including Excel, word, and internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively
• Ability to multi-task and remain focused while managing high-volume, time-sensitive workload.

Education and experience: 

• High School Diploma or GED required. Associates Degree preferred.
• Medical terminology desired. ICD-10/CPT coding experience strongly desired.
• Required: Minimum three years of experience in a Customer Service setting. Minimum of two years office employment within a health-related environment.  Computer literacy and working knowledge in Microsoft products.  Experience with multiple telephone lines, excellent communication skills and quality customer relation skills are required.  Medical terminology desired.  ICD-10/CPT coding experience
• Preferred:  Minimum one-year of previous experience in insurance verification and authorizations

Pay Range:

Starting Pay: 

Thompson Health is an EOE encouraging women, minorities, individuals with disabilities and veterans to apply