Prior Authorization Specialist

Job Description

Job Description

GENERAL SUMMARY:

The Prior Authorization Specialist will contact insurance companies, on behalf of Brown Surgical, to verify patient specific benefits and authorizations/referrals for surgical procedures and diagnostic imaging as required by the insurance carrier. The Prior Authorization Specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage. The Prior Authorization Specialist may be asked to work denials on the authorizations that had been obtained.

ESSENTIAL FUNCTIONS:

• Work closely with the staff to ensure that all authorizations are documented completely and submitted in a timely manner
• Communicate authorization denials to ordering physicians
• Prioritize and organize all prior authorization activities
• Serve as a liaison between patient, insurer, and practice
• Work on denials
• Prepare written communication to notify appropriate staff of authorization updates and or changes for insurance carrier
• Schedule peer-to-peer discussions if prior authorization is denied.
• Keep track of pending authorization until decision is made.
• Contact insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled treatment and/or retroactively as needed
• Secretarial responsibilities to division APPS including scheduling appointments, returning calls, Doc of the Day coordination, answering phones.
• Perform other duties as assigned by the Practice Manager

MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES:

• High school diploma or equivalent required
• Three to five years previous medical office experience is preferred
• One to two years of experience with prior authorization process
• Proficient in Microsoft Office Suite.
• Ability to deal tactfully and effectively with patients, family members, staff member, and physicians
• Excellent customer service and communication skills
• Ability to represent the organization and serve consumers in a professional manner and promote a positive image of the organization and its services.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

Conditions common to a clinical practice environment.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SUPERVISORY RESPONSIBILITY:

None.

Employees are required to be vaccinated against Covid as a condition of employment.

We value a diverse, talented workplace and seek colleagues who strive to better understand systemic barriers as it affects patient care and our academic institutions. Brown Surgical Associates welcomes nominations and applications from all individuals with varied experiences, perspectives, abilities, identities, and backgrounds to enrich our clinical, research, training and service missions.

Monday-Friday, 8:30AM-5:00PM