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Authorization Nurse Specialist

3 months ago

Germantown, Tennessee, United States Urology America, MSO Full time
GENERAL DESCRIPTION
Under the direct supervision of the Director of Clinical Operations, the Authorization Specialist is responsible for calling insurance companies to obtain prior authorization and precertification for services, procedures and medications. In addition, the Authorization Specialist Nurse must be able to provide efficient and proficient services to our physicians as well as provide quality, courteous and compassionate services to our patients in adherence to the guidelines, policies and procedures set forth by The Conrad Pearson Clinic.

ESSENTIAL JOB FUNCTIONS
  1. Responsible for prior authorization and precertification of eligible medical services, procedures and medication.
  2. Ensure complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services.
  3. Call/navigate insurance websites for authorization requirements and obtain timely authorizations from various insurance companies.
  4. Communicate with insurance carriers, both internal and external customers and patients via phone or written correspondence.
  5. Update task in the system to include approvals, coinsurance, copay, deductibles and authorization requirements.
  6. Initiate appeals for denied authorizations.
  7. Prioritize incoming prior authorization and precertification requests according to urgency.
  8. 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.
  9. Communicate regularly with supervisor, keeping him/her apprised of all pertinent information and providing feedback.
  10. 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.
  11. Support and adhere to all company policies, procedures and management decisions; maintain confidentiality of patients' medical information; and all confidential administrative related issues.
  12. 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.
  13. Demonstrate the ability to concentrate during the course of the day.
  14. Display a positive outlook with a helpful, constructive manner when working with other employees.
  15. 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.
OTHER DUTIES
  1. Perform other related duties as assigned or directed by CPC physicians and administrative staff.
  2. Complete other tasks as assigned.
POSITION REQUIREMENTS
  1. Completion of a nursing program from an accredited school is required.
  2. 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.
  3. Two years of clinical experience, preferably in a urology practice is required.
  4. Excellent oral and written communication, interpersonal, problem solving and organizational skills are required.
  5. Occasional overtime, evening and weekend work is required.
  6. A valid driver's license, dependable automobile and current auto insurance are required for occasional travel for business purposes and to work at satellite locations.
ESSENTIAL PHYSICAL REQUIREMENTS
  1. Requires prolonged sitting, some bending, stooping and stretching, or performing other work requiring moderate physical exertion.
  2. Capacity to maintain physical activity over prolonged periods of time (stamina).
  3. Able to see for the purpose of reading information received in different formats including but not limited to paper, computer, reports, bulletins and manuals.
  4. Able to hear for work-related purposes.
  5. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
  6. Able to lift up to a minimum of 25 pounds.
ESSENTIAL ENVIRONMENTAL CONDITIONS
  1. Work is generally performed under normal office working conditions.
  2. Normal level of visual strain.
  3. Ability to cope with stress caused by public interaction, multiple demands and extraneous noises.
  4. Possible exposure to contagious diseases.

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