Clinical Authorization Specialist

1 week ago

Manchester, New Hampshire, United States Panera Bread Full time

Come work at a leading organization dedicated to providing exceptional care.

Job Overview:

Position Summary

The Clinical Authorization Specialist plays a crucial role in ensuring that precertification processes are efficiently completed for patients, as mandated by insurance providers. This position encompasses various administrative responsibilities that support both clinical and provider needs.

We welcome applications from individuals with backgrounds in medical assisting, pharmacy technology, or other relevant clinical experiences, as these skills are highly beneficial.

Key Responsibilities

  • Secure authorization by researching ICD-10 codes, completing necessary authorization documentation, and ensuring that all clinical information is submitted to insurance companies.
  • Collaborate with staff to exchange information and receive updates regarding patient status or procedures, serving as a resource and educating colleagues on the precertification process.
  • Work with Patient Accounts to address billing and precertification concerns, providing necessary documentation as required.
  • Verify all self-pay accounts and conduct research to confirm the absence of other insurance coverage.
  • Develop proficiency in using current technologies, including electronic medical records and various office equipment.
  • Maintain organized electronic files, logs, and records for efficient retrieval and accurate tracking of production metrics.
  • Ensure confidentiality regarding employee, legal, client/patient, budget, and all company-related matters.
  • Prepare visit charts based on daily appointments, ensuring all relevant diagnostic test results and reports are accessible to providers.
  • Document information clearly and professionally.
  • Process medication prescription refills according to established guidelines using various communication methods.
  • Engage with patients in a timely and professional manner, addressing complaints or feedback appropriately.
  • Identify urgent situations and communicate them to the relevant personnel for timely intervention.
  • Participate in quality and regulatory initiatives, fostering teamwork and professional relationships within the organization.
  • Engage in continuing education to enhance personal knowledge and skills.
  • Cross-train as a patient service representative as necessary, including telephone coverage.

Education/Experience/Licensure

  • Education: High School diploma or GED required. Completion of an accredited Medical Assistant program or equivalent clinical experience in a healthcare setting is necessary.
  • Licensure: Medical Assistant certification is preferred.
  • Experience: A minimum of one year of experience as a Medical Assistant or in a similar clinical role is preferred, along with experience in customer service or office settings.

What We Offer

  • Comprehensive health, dental, prescription, and vision coverage for both full-time and part-time employees.
  • Short-term and long-term disability, as well as life insurance coverage.
  • Competitive compensation.
  • Tuition reimbursement programs.
  • 403(b) Retirement Savings Plan.

And more benefits await you.

Work Schedule:

Monday to Friday, 8 AM to 5 PM, totaling 32 hours weekly.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

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