Wisconsin Staffing
Prior Authorization Specialist
Wisconsin Staffing, Green Bay, Wisconsin, United States, 54311
Prior Authorization Specialist
The Prior-Authorization Specialist at Prevea Health is responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, services, and medications. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist will collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals. What you will do: Identify and obtain what is required for preauthorization of procedures, diagnostic tests, services, and medications. Seeing the process through completion to minimize denial of claims. Coordinate with department providers and staff, coding/billing staff, and insurance representatives to ensure understanding of information needed to obtain proper authorization for payment within the appropriate timelines. Review and interpret insurance coverage and policy guidelines to determine authorization requirements. Communicate with patients as needed for procedures, diagnostic tests, services, and medications to provide them with information regarding their coverage. Accurately document and communicate final determination in the patients medical record and to appropriate staff, providers, or patient. Work with internal teams to identify and address trends or issues in the prior authorization process. Provide feedback and recommendations to improve prior authorization workflows and efficiency. Education Qualifications: High School Diploma and/or GED Required Experience Qualifications: 1-3 years One year of experience in a medical or insurance role Required Skills and Abilities: Display proficient telephone and computer skills with clear and professional speaking abilities. Excellent organizational skills. Excellent communication skills and follow through with internal and external customers. Knowledge of insurance and medical terminology. Basic knowledge of current CPT/ICD coding. Able to provide exceptional customer service by assessing patient needs.
The Prior-Authorization Specialist at Prevea Health is responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, services, and medications. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist will collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals. What you will do: Identify and obtain what is required for preauthorization of procedures, diagnostic tests, services, and medications. Seeing the process through completion to minimize denial of claims. Coordinate with department providers and staff, coding/billing staff, and insurance representatives to ensure understanding of information needed to obtain proper authorization for payment within the appropriate timelines. Review and interpret insurance coverage and policy guidelines to determine authorization requirements. Communicate with patients as needed for procedures, diagnostic tests, services, and medications to provide them with information regarding their coverage. Accurately document and communicate final determination in the patients medical record and to appropriate staff, providers, or patient. Work with internal teams to identify and address trends or issues in the prior authorization process. Provide feedback and recommendations to improve prior authorization workflows and efficiency. Education Qualifications: High School Diploma and/or GED Required Experience Qualifications: 1-3 years One year of experience in a medical or insurance role Required Skills and Abilities: Display proficient telephone and computer skills with clear and professional speaking abilities. Excellent organizational skills. Excellent communication skills and follow through with internal and external customers. Knowledge of insurance and medical terminology. Basic knowledge of current CPT/ICD coding. Able to provide exceptional customer service by assessing patient needs.