Description

Job Summary:

The Prior Authorization Specialist is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of services provided. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorization for care. The Prior Authorization Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patients record.

Key Responsibilities:

? Verify insurance coverage and eligibility for patients.

? Answer telephone billing inquiries from customers, outside sources, and in-house personnel.

? Partner with appropriate staff and departments to ensure optimal working relationships.

? Maintain meticulous medical records.

? Obtain authorizations from insurance companies.

? Review medical records and documentation to ensure accurate coding.

? Work directly with billing to resolve any issues with insurance claims.

? Perform various follow up activities including telephone calls, appeals, letters and utilize payer websites to achieve timely resolution.

? Collaborate with surgical schedulers and billing to ensure smooth workflow and efficient patient care.

? Maintain confidentiality and adhere to HIPAA regulations.

? Other related duties as assigned by supervisor or leadership.

Requirements

? High School diploma or equivalent required-certificate or associate degree preferred 

? Minimum of two (2) years’ experience in billing/prior authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO’s and PPO’s required.

? Experience with Electronic Health Records (EHR), Athena Health preferred

? Medical insurance specialist experience in Vascular surgery is highly desired.

? Strong customer service background preferred.

? Understanding of insurances in the state of Virginia.

? Excellent communication and interpersonal skills.

? Attention to detail and accuracy.

? Must be a reliable professional.

? Excellent computer literacy.

? Ability to work independently and in a fast-paced environment.

? Excellent organizational and planning skills.

Summary