Prior Authorization Specialist

4 days ago


Appleton, Wisconsin, United States Neuroscience Group Full time
Job Overview

Neuroscience Group is seeking a highly skilled Prior Authorization Specialist to join our Clinical Services Team. As a key member of our team, you will be responsible for pre-authorizing ancillary testing and treatment conducted in our office and outside settings.

Key Responsibilities
  • Verify patient insurance information and make updates as needed.
  • Review clinical documentation for medical criteria and guidelines identified by insurance companies.
  • Review CPT and Diagnosis codes for accuracy before submitting to insurance.
  • Gather required information from patient charts, Epic, Care Everywhere, and outside locations.
  • Determine necessity for pre-authorization for each CPT code via phone call or portal review.
  • Initiate prior authorization via portal, fax form, or telephone call, uploading or faxing clinicals as required.
  • Follow up on pending authorization requests in a timely manner via portal or phone call.
  • Notify patients and practitioners of unauthorized services or referrals.
  • Review denied cases for additional information required or reason for denial, communicating reason to practitioner for guidance on next steps.
  • Schedule Peer to Peer based on criteria, reason for denial, and provider schedule.
  • Collaborate with provider on completion of appeal letter for submission to insurance.
  • Maintain good communication with patients, physicians, clinical services team, reimbursement services team, and outlying facility staff.
  • Utilize Faxfinder cloud faxing system for managing incoming and outgoing faxes.
  • Maintain timely, complete documentation and recordkeeping for accurate continuity of patient care.
  • Attend team and staff meetings regularly.
Requirements
  • Previous experience in medical preauthorization/precertification.
  • Knowledge of healthcare insurance and third-party payers, including VA and Work Comp.
  • Previous experience with CPT and ICD-10 coding.
  • Prior EPIC experience.
  • Ability to work independently and as part of a team.
Knowledge and Skills
  • Proficient computer knowledge and keyboarding skills, including Microsoft Office programs.
  • Medical terminology.
  • Excellent verbal and written communication skills.
  • Customer service experience.
  • Strong organizational skills.
  • Detail-oriented.
  • Ability to multi-task and remain focused while managing a high-volume, time-sensitive workload.
  • Critical thinking skills and decisive judgment.
Benefits

Neuroscience Group offers a competitive salary and a comprehensive benefits package, including no nights, no weekends, and no holidays, as well as health, dental, and vision insurance, company-paid long-term disability and life insurance, and a 401(k) plan with employer contribution.



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