BH Pre-Authorization Specialist

5 days ago


Valley Center, Kansas, United States Bryan Health Full time
BH Pre-Authorization Specialist Job Description

The BH Pre-Authorization Specialist plays a crucial role in ensuring seamless patient care by verifying demographic and insurance information, obtaining prior authorization for scheduled medical services, and exercising problem-solving skills to direct patients to cultural and community resources when necessary.

Key Responsibilities:
  1. Commitment to Mission and Values: Demonstrate a strong commitment to the mission, vision, and core values of Bryan Health.
  2. Patient Information Assembly: Gather and present relevant patient clinical background information to payer authorization representatives.
  3. Authorization and Verification: Obtain authorizations for services ordered for all payers (Medicare, Medicaid, and commercial plans) that require authorization.
  4. Collaboration with Business Office Team: Work closely with coders and billers to ensure accurate procedure and diagnosis codes are used in the pre-authorization process.
  5. Timely Completion of Requests: Complete all requests for authorizations in a timely manner.
  6. Documentation and Tracking: Accurately document all actions taken regarding the pre-authorization process, including documenting the pre-authorization number/code in the Practice Management system.
  7. Staying Current with Payer Guidelines: Remain up-to-date with all pre-authorization guidelines specific to all payers and inform staff and clinic administration as necessary.
  8. Effective Communication: Provide effective communication, proactively and in response, to patients/family members, team members, physicians, and other healthcare providers while maintaining confidentiality.
  9. Patient Outreach and Support: Contact patients to obtain missing demographic information, quote potential out-of-pocket obligations, and establish relationships with cultural and community resources for patients experiencing financial difficulty or cost concerns.
  10. Professional Development: Attend workshops to enhance pre-authorization skills and payer guidelines.

Education and Experience: High School diploma or equivalency required. Certified Medical Assistant or Licensed Practical Nurse preferred. Minimum of one (1) year work experience in a medical office setting required. Prior pre-authorization, coding, or medical billing experience preferred.



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