Job Description
GENERAL DESCRIPTION The Authorization Specialist is responsible for calling insurance companies to obtain prior authorization and precertification for services, procedures and medications.
ESSENTIAL JOB FUNCTIONS - Responsible for prior authorization and precertification of eligible medical services, procedures and medication.
- Ensure complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services.
- Call/navigate insurance websites for authorization requirements and obtain timely authorizations from various insurance companies.
- Communicate with insurance carriers, both internal and external customers and patients via phone or written correspondence.
- Update task in the system to include approvals, coinsurance, copay, deductibles and authorization requirements.
- Initiate appeals for denied authorizations.
- Prioritize incoming prior authorization and precertification requests according to urgency.
- Familiar with the practices and job duties at the Wolf River Clinic and all outlying clinics and is able and willing to work at these locations as needed.
- Communicate regularly with supervisor, keeping him/her apprised of all pertinent information and providing feedback.
- Ensure compliance for all regulatory requirements including OSHA, CLIA and HIPAA; immediately and accurately document and report occurrences to supervisor; and ensure compliance with all legal and regulatory requirements as outlined in the corporate compliance plan.
- Support and adhere to all company policies, procedures and management decisions; maintain confidentiality of patients’ medical information; and all confidential administrative related issues.
- Demonstrate dependability in attendance, punctuality in reporting for work and initiative in completing a full work schedule; meeting or exceeding all established deadlines and utilizing all resources and supplies efficiently and appropriately.
- Demonstrate the ability to concentrate during the course of the day.
- Display a positive outlook with a helpful, constructive manner when working with other employees.
- Demonstrate superior patient relations and interpersonal skills; demonstrate an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public using tact, sensitivity and sound judgment; promote a positive work environment and contribute to the overall efforts of the department and the company.
POSITION REQUIREMENTS - Completion of a nursing program from an accredited school is required.
- Current Registered Nurse (RN) or Licensure Practical Nurse (LPN) is required. Ten years of clinical experience will be considered in lieu of license requirement requirements.
- Two years of clinical experience, preferably in a urology practice is required.
- Excellent oral and written communication, interpersonal, problem solving and organizational skills are required.
- Occasional overtime, evening and weekend work is required.
ESSENTIAL PHYSICAL REQUIREMENTS - Requires prolonged sitting, some bending, stooping and stretching, or performing other work requiring moderate physical exertion.
- Capacity to maintain physical activity over prolonged periods of time (stamina).
- Able to see for the purpose of reading information received in different formats including but not limited to paper, computer, reports, bulletins and manuals.
- Able to hear for work-related purposes.
- Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
- Able to lift up to a minimum of 25 pounds.
ESSENTIAL ENVIRONMENTAL CONDITIONS - Work is generally performed under normal office working conditions.
- Normal level of visual strain when working on a computer.
- Ability to cope with stress caused by public interaction, multiple demands and extraneous noises.
- Possible exposure to contagious diseases.
Job Tags
Full time, Immediate start, Afternoon shift,