Prior Authorization Specialist
6 days ago
We are seeking a Prior Authorization Specialist to join our team at Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County.
Job Summary:
The Prior Authorization Specialist will be responsible for providing efficient and accurate information to prior authorization requests, ensuring correct benefits, co-pays, and financial responsibility are provided to requestors.
Key Responsibilities:
- Anticipate customer needs by understanding the process and job guidelines to provide accurate and timely information to the Prior Auth department.
- Data entry via GCEA/REA
- Verify eligibility and benefits on all requests from Prior Authorization.
- Verify financial responsibility for all requests.
- Maintain turnaround time compliance in all aspects of the UM process.
- Maintain all reference material provided by supervisors, managers, or directors.
- Know and follow Employee Handbook policies and procedures.
- Maintain patient confidentiality to ensure HIPAA compliance at all times.
- Demonstrate honesty and integrity in everyday activities.
- Recognize errors and immediately report to appropriate management.
- Maintain regulatory turn-around Time Standards per CMS (Seniors) and ICE (Commercial).
- Assist other staff and support the team approach.
- Participate in the efficient, effective, and responsible use of resources such as supplies and equipment.
- Communicate effectively and clearly with management and coworkers.
- Perform other duties as directed by management.
Requirements:
- 2-4 years of experience with HMO referrals and prior authorizations.
- Knowledge of Healthcare and Managed Care preferred.
- Typing 40 words per minute with accuracy.
- Knowledge of computers, faxes, printers, and all other equipment.
- Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point).
- Ability to multi-task and meet deadlines.
About Our Company:
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County offers a fast-paced, exciting, welcoming, and supportive work environment. We promote teamwork, nurture learning, and encourage advancement for all employees.
Estimated Salary Range:
$23 - $28 per hour, depending on individual factors, including market location, job-related knowledge, licensure, skills, and experience.
Benefits Package:
- Employer-paid comprehensive medical, pharmacy, and dental for employees
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health Services
Other Benefits:
- Vacation Time
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- Mileage
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