Kintegra Health
Prior Authorization Specialist
Kintegra Health, Gastonia, North Carolina, United States, 28054
Overview
Under the direct supervision of the Customer Care Manager, the Prior Authorization Specialist is responsible for obtaining pre-authorizations for medications and diagnostics, scheduling patients for outpatient testing, and coordinating patient orders.
Candidate Qualifications
Licensure/Certification: None
Education: High School Diploma Required
Experience: Previous experience in a clinic setting preferred.
Knowledge/Skills: Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data, good judgment, tact, diplomacy, and problem-solving ability. Able to work effectively in a team environment and use a personal computer and related software.
Minimum Qualifications: Must be able to sit, stand, and walk for long periods of time; read and understand English; maintain confidentiality of records; and communicate with all levels of personnel.
Job Responsibilities
Contact insurance carriers to verify patients’ insurance eligibility, benefits, and requirements.
Request, track, and obtain prior authorization from insurance carriers within the time allotted for medical services.
Request, follow up, and secure prior authorizations prior to services being performed.
Demonstrate and apply knowledge of medical terminology, high proficiency in general medical office procedures, and HIPAA regulations.
Communicate any insurance changes or trends among the team.
Maintain a level of productivity suitable for the department.
Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
Other duties as assigned.
Kintegra Health Core Requirements
Patient First – An approach to care that places the well‑being and desires of the patient first.
Build not Blame – Focusing first on finding fault with the process rather than the person.
Integrity and Honesty – Fostering an acceptance of openness, honesty, and fairness in words, deeds, and the use of organizational resources judiciously for both internal and external customers.
Cooperation and Flexibility – Belief that we function as part of an interdependent team with shared gains or losses, committed to assisting whenever possible beyond the prerequisite job description.
Culturally Sensitive – Constantly working to increase ability to understand, communicate with, effectively interact, and care for people across cultures, while maintaining an acute awareness of one’s own culture.
Job Details
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industries: Hospitals and Health Care
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Candidate Qualifications
Licensure/Certification: None
Education: High School Diploma Required
Experience: Previous experience in a clinic setting preferred.
Knowledge/Skills: Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data, good judgment, tact, diplomacy, and problem-solving ability. Able to work effectively in a team environment and use a personal computer and related software.
Minimum Qualifications: Must be able to sit, stand, and walk for long periods of time; read and understand English; maintain confidentiality of records; and communicate with all levels of personnel.
Job Responsibilities
Contact insurance carriers to verify patients’ insurance eligibility, benefits, and requirements.
Request, track, and obtain prior authorization from insurance carriers within the time allotted for medical services.
Request, follow up, and secure prior authorizations prior to services being performed.
Demonstrate and apply knowledge of medical terminology, high proficiency in general medical office procedures, and HIPAA regulations.
Communicate any insurance changes or trends among the team.
Maintain a level of productivity suitable for the department.
Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
Other duties as assigned.
Kintegra Health Core Requirements
Patient First – An approach to care that places the well‑being and desires of the patient first.
Build not Blame – Focusing first on finding fault with the process rather than the person.
Integrity and Honesty – Fostering an acceptance of openness, honesty, and fairness in words, deeds, and the use of organizational resources judiciously for both internal and external customers.
Cooperation and Flexibility – Belief that we function as part of an interdependent team with shared gains or losses, committed to assisting whenever possible beyond the prerequisite job description.
Culturally Sensitive – Constantly working to increase ability to understand, communicate with, effectively interact, and care for people across cultures, while maintaining an acute awareness of one’s own culture.
Job Details
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industries: Hospitals and Health Care
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