PRIOR AUTHORIZATION SPECIALIST

WFH Flexible • Emmett, ID (http://maps.google.com/maps?q=OFF-SITE+Emmett+ID+USA)

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Description

Position Title: Prior Authorization Specialist

Department: Business Office

Supervisor’s Title: HIM/Business Office Manager

IHA# Position Summary:

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures performed at Valor Health. Developing and implementing prior authorization workflow, policies, and procedures. Principal Functions and Responsibilities:

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.

• Request, follow up and secure prior authorizations prior to services being performed at Valor Health.

• Prioritize incoming authorization requests according to urgency.

• Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.

• When necessary, work with billing specialist to obtain a retro authorization.

• Assist with medical necessity documentation and submit medical records to expedite approvals and ensure that appropriate follow up is performed.

• Review accuracy and completeness of information requested and ensure that all supporting documents are present.

• Responsible for reviewing all encounters and mailing out Consolidated Summary of

• Attends and participates in meetings as requested.

• Performs other duties as assigned.

Requirements

Position Qualifications/Requirements/preferences:

• Minimum Education: High school diploma or equivalent.

• Minimum of 3 years’ experience working in healthcare.

• Minimum of 2 years’ experience as a Medical Assistant/CAN/LPN

• Preferred experience with obtaining prior authorizations.

• Ability to communicate effectively with a wide variety of contacts at all levels of the organization.

• Must have strong organizational skills and attention to detail.

• Strong work ethic and ability to apply critical thinking to a variety of practical and time sensitive situations.

• Working knowledge of Microsoft Office including Word, Excel, and Outlook are required.

• Consistent professionalism in both presentation and demeanor.

• Ability to work with minimal supervision and as a member of a team.

• Ability to Flex Schedule to adjust to workflow.

Working Conditions:

• Primarily office work. Positions is flexible to be in suite, remote or hybrid.

• General Health care environment exposure to patient conditions.

• Physical Requirements: Standing, walking, bending, stooping, sitting, hand eye coordination, speaking.