Prior Authorization Specialist

3 weeks ago


Detroit, United States KYYBA Full time
Job DescriptionJob Description

Title:                     Prior Authorization Specialist

Location:             Detroit, MI (100% REMOTE, training for 4-6 weeks onsite)

Duration:            Long term duration

·         Support health care payer providers and UM reviewers with prior authorization requests for post-acute care services.

·         Includes manually entering authorization requests into client's Care Management systems, following rules and algorithms embedded in the care management system to administratively approve prior authorization requests.

·         May work with providers to secure discharge plans, Notice of Non-Medical Coverage, Durable medical equipment, and other home supports required for discharge planning.

·         May support scheduling physician to physician calls.

·         Will support appeal processes for CMS designated Quality Improvement Organization appeals including logging all appeal activities.

·         High School Graduate or GED equivalent required. Two (2) years of college preferred.

·         Two (2) years’ experience as medical assistant, care technician, post-acute care and home health care support staff or ancillary services in other health care related field preferred.

·         Knowledge post-acute care functions and processes or discharge readiness activities may be preferred for some positions.

Certification

·         Certified Medical Assistant / Certified Medical Coder / Certified Medical Reimbursement Specialist – Any certification is nice to have.

 



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