Prior Authorization Specialist

Job Description:

In office position located at our Corporate office.

Authorization of procedures in office and an ambulatory surgery center as ordered by the practice providers.

Completes all duties related to precertification and authorization for procedures performed by the providers of Comprehensive Pain Management Specialists and cross training in procedure scheduling to cover as needed.

RELATIONSHIPS AND CONTACTS:

Has daily contact with direct Manager and other staff of Corporate Office. Has daily contact with insurance companies, and patients via phone. Direct contact with providers for verification on procedure orders and medical necessity requirements.

ESSENTIAL FUNCTIONS:

• Obtains procedure authorization and insurance verification as needed for all providers.
• Serves as contact for BWC and obtains C-9.
• Review of insurance company medical policies/benefits.
• Documents information as required.
• Answers phone calls. Returns calls promptly (with 24 hours).
• Messages physicians and staff appropriately.
• Schedules and reschedules procedure appointments as needed.
• Communicates information to site staff, billing, surgical center(s) and hospital(s).
• SPECIFIC FUNCTIONS: Responsible for correctly handling multiple requests and duties.

MARGINAL FUNCTIONS:

1. Perform general clerical/secretarial duties as required.

2. Report needs for supplies, equipment, forms, etc. to the individual designated or to the Supervisor.

3. Report equipment malfunctions to the Supervisor.

4. Keeps work area neat and assists with other department cleaning as required.

5. Correspondence, typing, web portal submissions, faxing authorizations

6. Performs other related duties as assigned by the Supervisor or Director.

7. Scanning, attaching PDF documents

8. Assist in training new employees as needed.

Job Type: Full-time

Pay: $18.00 - $20.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Education:

• High school or equivalent (Required)

Experience:

• ICD-10: 1 year (Preferred)
• Authorization: 1 year (Required)
• Insurance verification: 1 year (Required)

Work Location: In person