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Prior Authorization Specialist

3 months ago

Queensbury, United States Hudson Headwaters Health Network Full time
Job DescriptionJob Description


HHHN Mission

To provide the best health care, and access to that care, for everyone in our communities.

HHHN Vision

To pioneer an innovative, sustainable and community-focused health system through comprehensive primary care and diverse partnerships

Proposed Schedule: 40 hours per week. Monday - Friday 8am-5pm.

Note: This is a remote position but must live within driving distance of Queensbury, NY.

Position Summary

The Authorization Specialist ensures that authorization for various services performed in the health center(s) has been obtained from insurance companies when required. This position is also responsible for basic administrative/clerical support.

Essential Duties and Responsibilities:

  • Complete Prior Authorizations which include, but are not limited to outpatient treatments, medications and some diagnostic testing (i.e. labs, pharmacy, infusions, internal procedures and Worker’s Comp)
  • Utilize established guidelines to ensure that all necessary information has been completely and accurately given to insurance companies in order to obtain authorization for services
  • Documents and provides updates in the patient’s medical record, the status of the referral and/or authorization
  • Responsible for verifying insurance policy benefit information, and securing payer required referrals and authorizations
  • Protect the confidentiality of patient’s electronic medical record in accordance with policy and procedure
  • Follow up in a timely manner on insurance determinations regarding submitted requests
  • Obtain retro authorizations as needed
  • Acts as a resource to all internal and external customers, offering guidance and support for authorization related questions and authorization processing problems
  • Adhere to the guidelines as set forth in the Networks Remote Work Program and Expectations policy on the HWEB
  • Enthusiastically support the Mission, Vision, and Core Values of Hudson Headwaters Health Network.
  • Perform additional duties and special projects as assigned

Qualifications:

The requirements listed below are representative of the knowledge, skill and ability to perform the essential functions:

  • High School Diploma with one year of medical office experience
  • Familiarity with Cover My Meds preferred
  • Pharmacy Technician experience preferred
  • Previous Electronic Medical Record experience
  • Knowledge of medical terminology, diagnosis and procedure coding
  • Medical insurance knowledge
  • Strong computer competency
  • Demonstrated ability to manage multiple tasks and prioritize workload
  • Ability to work independently and be a team player
  • Ability to communicate effectively via mail, phone, electronic medical record and verbally

The pay rate for this position is $18.50 per hour.