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Pre-Authorization Specialist
2 months ago
Associated Urologists of North Carolina is seeking a highly skilled Pre-Authorization Specialist to join our team. As a key member of our team, you will be responsible for managing the pre-authorization process, collaborating with insurance companies, and communicating with patients and healthcare providers.
Key Responsibilities:- Pre-Authorization Management: Assist with medical necessity documentation to expedite approvals and ensure that all necessary follow-up is performed.
- Workflow Development: Develop and implement prior authorizations workflows, policies, and procedures.
- Collaboration: Collaborate with other departments to obtain pre-authorizations in a cross-functional manner.
- Information Review: Review accuracy and completeness of information requested and ensure that all supporting documents are present.
- Request Management: Receive and monitor requests for pre-authorizations.
- Medical Record Submission: Submit medical records to insurance carriers to expedite prior authorization processes.
- Correspondence Management: Manage correspondence with insurance companies, physicians, specialists, and patients as required.
- Denial Review: Review denials and submit appeals to obtain approval from insurance companies.
- Account Updates: Update patient accounts with pre-authorization information and ensure that all procedures are in compliance with HIPAA regulations.
- Financial Evaluation: Evaluate patient accounts to determine portions to be paid by the customer and document this information.
- Education: High school diploma or equivalent from a two-year college or technical school or six months to one-year related experience and/or training preferred.
- Experience: Typically requires 0-2 years of related experience.
- Knowledge: Knowledge of medical and insurance terminology, specifically collecting co-pays and co-insurance, and of the services provided by the practice.
- Math Skills: Knowledge of basic math skills.
- Language Skills: Good command of the English language. Knowledge of Spanish is a plus.
- Relationship Building: Establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
- Problem-Solving: Recognizing, evaluating, solving problems, and correcting errors.
- Multi-Tasking: Multi-tasking and staying focused on the immediate task.
- Communication: Communicating in writing, over the telephone, and in person with office staff and patients.
- Interpersonal Skills: Interacting with patients, medical and administrative staff, and the public effectively.
- Customer Service: Eliciting appropriate information to route calls and assist persons with their needs.
- Conflict Resolution: Preventing, calming, or defusing irate or upset patients by working with them to identify concerns and find assistance.
This position is located in a well-lighted, temperature-controlled office environment.
