Prior Authorization Specialist

3 weeks ago

Junction City, United States Konza Prairie Community Health Center Full time
Job DescriptionJob DescriptionDescription:

The Prior Authorization Specialist will perform all tasks related to the initiation and completion of prior authorizations, referral process, and medical correspondence/ records.


ESSENTIAL JOB FUNCTIONS:

  1. Responsible for working with third parties like insurance companies, hospitals, imaging facilities, to gain prior authorization and schedule patient medical services.
  2. Responsible for processing, maintaining, and closing prior authorizations.
  3. Responsible for following up with specialty provider’s office and closing referral loop upon receipt of consult notes or result documentation.
  4. Responsible for categorizing and assigning the incoming Lab and Diagnostic Imaging to order with result to respective Provider.
  5. Responsible for refill requests from outside pharmacies and correspondence appropriate to addressing tasks.
  6. Actively maintains third party sites for shared patient medical records to promptly close referral loop.
  7. Prioritizes and processes referrals by urgency or PCP request.
  8. Performs prior authorizations for outbound referrals and diagnostic imaging.
  9. Manages medical records by sorting, filing, and collecting a variety of medical records and information such as admission slips, laboratory and pathology reports, operative notes, clinic notes, discharge summaries in the patient medical records in the appropriate sequence and in accordance with established procedures.
  10. File and retrieve medical records and research lost or missing records in accordance with established procedures.
  11. Closely examines patient medical records for completeness ensuring all required information is included. Follows up to obtain missing records.
  12. Manages incoming faxes and timely categorizes, distributes, and attaches documents to appropriate parties in accordance with established priorities and procedures.
  13. Participates in Quality Improvement activities.
  14. Performs other duties as assigned by supervisor.
Requirements:
  1. High School diploma or GED is required.
  2. 1-3 years of EMR experience required.
  3. 1-3 years working with insurance companies and managing medical records required.
  4. 1 year experience working in a family practice or hospital setting is required.
  5. Knowledge pre-authorization preferred.
  6. Graduate of certified medical office training course preferred.

Join our team at Konza Prairie Community Health Center and experience a workplace that truly values your well-being. We take pride in offering a comprehensive range of employee benefits designed to support your health, financial security, and work-life balance. Here's what you can expect:

  • Medical, Dental, and Vision Coverage: Take advantage of our robust health plans to ensure you and your family's well-being.
  • Paid Time Off (PTO): Generous PTO accrual of up to 7.71 hours per pay period for a healthy work-life balance.
  • 403(b) Retirement Plan with Employer Match: Secure your financial future with our retirement savings plan, complemented by employer contributions.
  • Employee Discounts: Insured employees and their immediate family members can enjoy exclusive discounts when utilizing Konza's in-house medical, dental, and pharmacy services.
  • Early Friday Closure: Konza clinics close at 2 pm every Friday, allowing you to kick off your weekend early.

At Konza, we are committed to fostering a workplace that celebrates diversity and inclusivity. We believe in the power of different perspectives, backgrounds, and experiences to drive innovation and success. We are an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

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