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Prior Authorization Specialist

3 months ago

Detroit, United States TekWissen LLC Full time
Job DescriptionJob DescriptionOverview: TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc. Title: Prior Authorization Specialist Work Location: Detroit, MI, 48243 Duration: 12 Months Job Type: Contract Work Type: Onsite Training and later Remote Dept: UM Program Mgmt
Engagement Description:
  • Support client providers and UM reviewers with prior authorization requests for post-acute care services.
  • Includes manually entering authorization requests into client 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.
TekWissen Group is an equal opportunity employer supporting workforce diversity.