Prior Authorization Representative

Description The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribes and triages patient calls to physicians, and coordinates patient appointments/orders. Requirements Essential Functions and Responsibilities: Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements. Request, track and obtain pre-authorization from insurance carriers within time allotted for patient expense may include medical, surgical, products, and/or services. Request, follow up and secure prior authorizations prior to services being performed and/or products being purchased. Demonstrate and apply knowledge of optical and/or ophthalmology terminology, high proficiency of general medical office procedures including HIPAA regulations. Communicate any insurance changes or trends among team. Maintains 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. Supervisory Responsibility: Position reports to Revenue Cycle Manager or designee No direct reports Working Conditions and Environmental/Physical Demands: Sedentary work that primarily involves sitting/standing. Moving about to accomplish tasks or moving from one worksite to another. Light work that includes moving objects up to 20 pounds. Communicating with others to exchange information. Repeating motions that may include the wrists, hands and/or fingers. No adverse environmental conditions expected. Position/Type/ Expected Hours of Work: This is a full-time onsite position and core hours of work and days are generally Monday through Friday 8:00 a.m. to 5:00 p.m. Potential for evening and weekend hours as required. Travel: Travel my be required to support the need to attend business meetings and/or training. Qualifications: Minimum of 2 years of performing pre-authorization in a clinic or similar setting Medicaid, Medicare, and other third-party payor reimbursement guidelines and requirements Experience working with confidential medical information Experience in computer programs such as EMRs, Word, Excel Skills and Abilities: Ability to navigate various websites and carrier portals Highly organized with developed time management skills Excellent customer service and telephone etiquette Excellent verbal and written communication skills Strong research and problem-solving skills; attentive to details Ability to operate a computer and general office machines Must be self-directed, able to work independently, as well as work in a team-oriented and fast paced environment Ability to clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.

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