Konza Prairie Community Health Center
Prior Authorization Specialist
Konza Prairie Community Health Center, Junction City, Kansas, United States, 66441
Prior Authorization Specialist
Join our team at Konza Prairie Community Health Center. This role coordinates patient care by managing all aspects of prior authorizations, referrals, and medical record correspondence to ensure accuracy, timeliness, and continuity of care.
Essential Job Functions
Collaborate with third parties (insurance companies, hospitals, imaging facilities) to obtain prior authorizations and schedule patient medical services.
Process, maintain, and close prior authorization requests.
Follow up with specialty provider offices and close referral loops upon receipt of consult notes or results.
Categorize and assign incoming lab and diagnostic imaging results to the appropriate provider.
Manage refill requests from outside pharmacies and ensure accurate communication with providers.
Maintain third-party portals for shared medical records to ensure prompt referral closure.
Prioritize and process referrals based on urgency or provider request.
Complete prior authorizations for outbound referrals and diagnostic imaging.
Sort, file, and manage medical records (admission slips, lab/pathology reports, operative notes, clinic notes, discharge summaries) ensuring proper sequencing and compliance.
Retrieve and track missing medical records as needed.
Review records for completeness and follow up on missing documentation.
Manage incoming faxes by categorizing, distributing, and attaching documents to the correct records.
Participate in quality improvement activities and other duties as assigned.
Requirements
High school diploma or GED required.
Minimum 1 year of experience with electronic medical records required.
At least 2 years of face‑to‑face experience with medical patients preferred.
At least 4 years of customer service experience preferred.
Knowledge of healthcare payment methodologies, including Medicare, Medicaid, HMOs, PPOs, and secondary payers, preferred.
Minimum 1 year of experience in a family practice or hospital setting preferred.
Completion of a certified medical office training course preferred.
Benefits
Medical, Dental, and Vision Coverage
Paid Time Off (PTO): Generous PTO accrual of up to 7.71 hours per pay period.
403(b) Retirement Plan with Employer Match.
Employee Discounts.
Early Friday Closure at 2:00 pm.
We are an Equal Opportunity Employer, and all qualified applicants will be considered without discrimination.
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Essential Job Functions
Collaborate with third parties (insurance companies, hospitals, imaging facilities) to obtain prior authorizations and schedule patient medical services.
Process, maintain, and close prior authorization requests.
Follow up with specialty provider offices and close referral loops upon receipt of consult notes or results.
Categorize and assign incoming lab and diagnostic imaging results to the appropriate provider.
Manage refill requests from outside pharmacies and ensure accurate communication with providers.
Maintain third-party portals for shared medical records to ensure prompt referral closure.
Prioritize and process referrals based on urgency or provider request.
Complete prior authorizations for outbound referrals and diagnostic imaging.
Sort, file, and manage medical records (admission slips, lab/pathology reports, operative notes, clinic notes, discharge summaries) ensuring proper sequencing and compliance.
Retrieve and track missing medical records as needed.
Review records for completeness and follow up on missing documentation.
Manage incoming faxes by categorizing, distributing, and attaching documents to the correct records.
Participate in quality improvement activities and other duties as assigned.
Requirements
High school diploma or GED required.
Minimum 1 year of experience with electronic medical records required.
At least 2 years of face‑to‑face experience with medical patients preferred.
At least 4 years of customer service experience preferred.
Knowledge of healthcare payment methodologies, including Medicare, Medicaid, HMOs, PPOs, and secondary payers, preferred.
Minimum 1 year of experience in a family practice or hospital setting preferred.
Completion of a certified medical office training course preferred.
Benefits
Medical, Dental, and Vision Coverage
Paid Time Off (PTO): Generous PTO accrual of up to 7.71 hours per pay period.
403(b) Retirement Plan with Employer Match.
Employee Discounts.
Early Friday Closure at 2:00 pm.
We are an Equal Opportunity Employer, and all qualified applicants will be considered without discrimination.
#J-18808-Ljbffr