Prior Authorization Specialist

4 months ago

Davenport, United States Orthopaedic Specialists PC Full time
Job DescriptionJob Description

JOB SUMMARY: Primary responsibility: To obtain prior authorization for all medical procedures, surgeries, or DME. To inform and obtain pre-payments, if necessary. To inform patients of the expectation of payment from their insurance company and their co-insurance.

EDUCATIONAL REQUIREMENTS:

  • Associate’s Degree and / or previous billing experience, including, but not limited to certification.

QUALIFICATIONS AND EXPERIENCE:

  • Two to three years of billing in private practice setting desired.
  • Knowledge of the accounts receivable process.
  • Ability to perform multiple tasks simultaneously, and work under pressure.
  • Excellent communication and organizational skills required. Attention to detail is imperative.
  • Ability to work independently and as part of a team. Flexible to work in a variety of areas, as needed.
  • Ability to establish and maintain positive and effective working relationships with patients, coworkers, and other health care providers and the public under stressful conditions.
  • Comfortable using email and interacting with internet applications.

Responsibilities include, but are not limited to, the following:

Duties:

  • Has excellent communication and organizational skills. Is able to multi task, is a team player, able to work independently, is flexible to work in variety of areas as needed.
  • Positive and friendly with patients and insurance company staff.
  • Ability to establish and maintain effective working relationships with patients, coworkers, other health care providers and the public under stressful conditions.
  • Attention to detail is imperative.
  • Obtains authorizations as needed for: surgery, procedures, splints, MRI’s, PT and any additional areas needing pre-authorization.
  • Superior verbal communication skills.
  • Faxes paperwork to various entities as needed.
  • Calls patients prior to surgery with payment information.
  • Comfortable using email and interacting with Internet applications.
  • Ability to perform multiple tasks simultaneously, and work under pressure.
  • Knowledge of practice management and word processing software.
  • Knowledge of the accounts receivable process.
  • Maintain detailed, accurate and organized files.
  • Maintain and achieve AR goals for best practices and benchmarking.
  • Be able to perform fundamental billing duties in a back-up capacity.
    • Investigate claim problems and expedites solutions.
    • Handle requests for office/operative notes directly related to claims processing.
    • Perform month end duties.
  • Maintain and achieve AR goals for best practices and benchmarking.

Other

  • Attends AAOS, BONES, Medicare, Medicaid and carrier updates and seminars annually upon request
  • Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice
  • Maintains detailed knowledge of practice management and other computer software as it relates to job functions
  • Attends continuing education courses as requested
  • Attends all meetings as requested
  • Performs any additional duties as requested by the Supervisor/Manager
  • Sets and exemplifies high ethical standards and holds self and others accountable for conduct.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Typical Physical Demands

Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and eyesight to record, prepare, and communicate appropriate reports.

Typical Working Conditions

Normal office environment.



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