Rural Health Group, Inc.
Prior Authorization Specialist
Rural Health Group, Inc., Roanoke Rapids, North Carolina, United States, 27870
Rural Health Group is seeking a full-time Prior Authorization Specialist at our RHG @ Halifax Medical Specialist office.
A prior authorization specialist is an individual who is highly skilled in ensuring that patients receive the medication and/or diagnostic services that requires pre-authorization from insurance carriers. These individuals address and rectify rejected claims and conduct necessary third party authorization requests.
Good Judgment
Communication/Customer Service/Teamwork
Passion
Honesty
Responsibility
Job-Specific Skill Set
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
Follow prior authorization work flow policies and procedures
Collaborate with other departments to assist in obtaining prior authorizations.
Review accuracy and completeness of information requested and ensure that all supporting documents are present
Receive requests for prior authorizations and ensure that they are properly and closely monitored.
Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes
Manage correspondence with insurance companies, clinicians and patients as required
Document all prior authorization information including approval dates, prior authorization number in hospital system
Proactively work on prior authorizations that are timely
Secure patients’ demographics and medical information by ensuring that all procedures are in sync with HIPAA compliance and regulation
Advise providers and their clinical staff when issues arise relating to obtaining prior authorization
Stay informed and research information regarding insurance criteria changes/updates for prior authorization
REQUIREMENTS
High school diploma or GED.
2+ years of related experience; prior- authorization experience highly desired
Knowledge of medical terminology
Understanding of insurance requirements for prior authorization
Experience in Radiology / Pharmacy / Laboratory Prior Authorizations
Understanding of CPT codes and vast knowledge of insurance required
Knowledge of eCW or other electronic health record preferred
Knowledge of Commercial Payors, Medicare & Medicaid desired
Excellent verbal, written, organizational and customer service skills
Ability to work independently, meet deadlines and be flexible
Ability to perform tasks accurately and efficiently when entering data electronically
Proficient typing/keyboarding skills
Basic knowledge of Microsoft Office, Excel and Outlook
Physical Demands: Must be able to sit for long periods of time. Must be able to lift 25-50 pounds. Must be able to ambulate for extended periods of time.
Embraces the team concept; encourages and models healthy, productive team behavior
Bilingual (English/Spanish) is a plus, but not required - applicants who may serve in a translating capacity will be required to take a language assessment
EOE. Federal and State Criminal Background Checks and Drug Screen required for all positions. The Influenza vaccine is a condition of employment.
E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.
#J-18808-Ljbffr
A prior authorization specialist is an individual who is highly skilled in ensuring that patients receive the medication and/or diagnostic services that requires pre-authorization from insurance carriers. These individuals address and rectify rejected claims and conduct necessary third party authorization requests.
Good Judgment
Communication/Customer Service/Teamwork
Passion
Honesty
Responsibility
Job-Specific Skill Set
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
Follow prior authorization work flow policies and procedures
Collaborate with other departments to assist in obtaining prior authorizations.
Review accuracy and completeness of information requested and ensure that all supporting documents are present
Receive requests for prior authorizations and ensure that they are properly and closely monitored.
Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes
Manage correspondence with insurance companies, clinicians and patients as required
Document all prior authorization information including approval dates, prior authorization number in hospital system
Proactively work on prior authorizations that are timely
Secure patients’ demographics and medical information by ensuring that all procedures are in sync with HIPAA compliance and regulation
Advise providers and their clinical staff when issues arise relating to obtaining prior authorization
Stay informed and research information regarding insurance criteria changes/updates for prior authorization
REQUIREMENTS
High school diploma or GED.
2+ years of related experience; prior- authorization experience highly desired
Knowledge of medical terminology
Understanding of insurance requirements for prior authorization
Experience in Radiology / Pharmacy / Laboratory Prior Authorizations
Understanding of CPT codes and vast knowledge of insurance required
Knowledge of eCW or other electronic health record preferred
Knowledge of Commercial Payors, Medicare & Medicaid desired
Excellent verbal, written, organizational and customer service skills
Ability to work independently, meet deadlines and be flexible
Ability to perform tasks accurately and efficiently when entering data electronically
Proficient typing/keyboarding skills
Basic knowledge of Microsoft Office, Excel and Outlook
Physical Demands: Must be able to sit for long periods of time. Must be able to lift 25-50 pounds. Must be able to ambulate for extended periods of time.
Embraces the team concept; encourages and models healthy, productive team behavior
Bilingual (English/Spanish) is a plus, but not required - applicants who may serve in a translating capacity will be required to take a language assessment
EOE. Federal and State Criminal Background Checks and Drug Screen required for all positions. The Influenza vaccine is a condition of employment.
E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.
#J-18808-Ljbffr