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Prior Authorization Specialist

2 months ago

Grand Rapids, Michigan, United States Haven Spine + Pain Full time
Job Summary

We are seeking a highly organized and detail-oriented Prior-Authorization Specialist to join our team at Haven Spine + Pain. As a key member of our clinical team, you will be responsible for verifying patient insurance eligibility, benefits, and requirements, as well as requesting and securing prior authorizations prior to services being performed.

Key Responsibilities
  • Contact insurance carriers to verify patient insurance eligibility, benefits, and requirements
  • Review documentation to ensure all medical policy guidelines are met
  • Request, follow up, and secure prior authorizations prior to services being performed, including appeals if necessary
  • Communicate with patients to discuss prior authorization status
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures, including HIPAA regulations
  • Communicate any insurance changes or trends among team members
  • Maintain a level of productivity suitable for the department
  • Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
Requirements
  • High school diploma or GED
  • Previous experience within a clinical setting and/or with health insurance carriers required
  • Previous prior authorization experience preferred
  • Excellent verbal and written communication skills
  • Effective customer relation skills
  • Must be highly organized
Physical Demands

This role requires the ability to be independently mobile to perform tasks, sit for up to 8 hours per shift, and push, pull, or lift up to 60 pounds.