Prior Authorization Specialist

2 weeks ago

Owosso, Michigan, United States Memorial Healthcare Full time
Job Summary

The Prior Authorization Coordinator will serve as a key member of the Memorial Healthcare team, providing exceptional support in the process of collecting necessary documentation for approval of hospital diagnostic testing, outpatient procedures, surgeries, injections, infusions, medication needs, and other requirements. This role will educate the team on third-party requirements for services and exhibit excellent customer service skills, effective communication, and problem-solving abilities.

This position requires a strong understanding of patient and family-centered care, as well as the ability to maintain confidentiality and work in a well-organized environment. The ideal candidate will be able to perform all aspects of the job, including verifying patient insurance benefits, eligibility, and network status, submitting insurance authorizations, and communicating with providers and staff.

The Prior Authorization Coordinator will be responsible for tracking patients' authorizations, verifying diagnosis codes and procedures, and ensuring reimbursement by payers. This role will also provide training programs and educational activities for the team, communicate effectively with all team members, and maintain a well-organized environment.

This is an excellent opportunity for a detail-oriented and customer-focused individual to join the Memorial Healthcare team and contribute to the patient and family experience.

Primary Job Responsibilities

  • Verify patient insurance benefits, eligibility, and network status
  • Submit insurance authorizations and understand payer requirements and timelines
  • Communicate with providers and staff regarding authorization and prior approval processes
  • Track patients' authorizations and verify diagnosis codes and procedures
  • Provide training programs and educational activities for the team
  • Communicate effectively with all team members and maintain a well-organized environment

Departmental and Additional Job Responsibilities

  • Special projects as assigned by the Manager of Patient Access or Director of Revenue Cycle
  • Other duties as assigned

Job Specifications

  • High School diploma/GED required; Associate degree preferred
  • Medical Terminology required; post-high school courses in coding, health insurance, and/or office procedures preferred
  • Minimum two years' pre-certification experience preferred
  • Excellent phone and customer service skills
  • Knowledge of health insurance plans, including benefits and authorizations
  • Ability to effectively listen and solve problems quickly
  • Ability to navigate a patient's chart within the EMR
  • Previous experience with prior authorizations required; Medical Assistant certification preferred
  • Experience with Oncology, Pharmacy, or Physician office authorizations preferred

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