Prior Authorization Specialist

6 days ago


Detroit, Michigan, United States w3r Consulting Full time
Job Summary

We are seeking a skilled Prior Authorization Specialist to join our team at w3r Consulting. As a key member of our healthcare operations team, you will play a critical role in supporting providers and UM reviewers with prior authorization requests for post-acute care services.

Responsibilities
  • Enter authorization requests into Care Management systems, following rules and algorithms embedded in the system to administratively approve prior authorization requests.
  • Work with providers to secure discharge plans, Notice of Non-Medical Coverage, Durable medical equipment, and other home supports required for discharge planning.
  • Support scheduling physician to physician calls.
  • Support appeal processes for CMS designated Quality Improvement Organization appeals, including logging all appeal activities.
Qualifications
  • 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 healthcare related field preferred.
  • Knowledge of post-acute care functions and processes or discharge readiness activities may be preferred for some positions.


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