Responsible for assisting with: Obtaining Prior Authorizations for scheduled services at Welia Health in accordance with the payer-provider contract. The Prior Authorizations Specialist contacts payers to request services authorization.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
Verify patients' insurance and benefit information.
Obtains prior authorization from third-party payers in accordance with payer requirements.
Obtain authorizations for procedures for Workers Compensation patients
Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
Works with other departments to gather the clinical information required by the payer to authorize services.
Keep accurate records of authorizations within the EMR.
Communicates with scheduling staff after prior authorization is obtained.
Communicates with Patient Services Representative if prior authorization is not obtained.
Works with business office staff to support appeal efforts for authorization-related denials.
Promote service excellence by demonstrating polite, cooperative and respectful behavior to both internal and external customers.
Assume responsibility for completing mandatory educational requirements.
Safeguard security and confidentiality of data/information according to HIPAA guidelines.
This job has no supervisory responsibilities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Knowledge of Microsoft office products, ability and willingness to learn new software products as needed.
EDUCATION and/or EXPERIENCE
Associates degree in healthcare or business administration and/or related coursework or comparable experience of minim of 2 years in a related healthcare field such as coding, billing, nursing etc. Must have excellent customer service and communication skills along with computer and clerical skills.
Familiar with medical terminology and healthcare insurance processes
Ability to work independently with strong attention to detail.
Ability to prioritize and multitask
Ability to perform routine and complex procedures
Ability to recognize problems, identify the cause and implement the solution
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
The responsibilities in this position are representative of Class III OSHA.