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Prior Authorization Specialist

1 month ago

Detroit, United States LanceSoft Full time
Job Description
  • Training will be onsite in Detroit, MI - Thereafter it's a remote role
  • Support Client's 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 Client designated Quality Improvement Organization appeals including logging all appeal activities.
Requirements:
  • High School Graduate or GED equivalent required.
  • Two years of college preferred.
  • Two 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.