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Authorization Specialist
2 months ago
We're a physician-led, patient-centric network dedicated to simplifying healthcare and delivering connected care. Our multispecialty and urgent care providers serve millions of patients through our operating companies, including VillageMD, Village Medical, Summit Health, CityMD, and Starling Physicians.
As a key member of our team, you'll play a vital role in ensuring seamless patient care. Your expertise will help us innovate value-based care and leverage integrated applications to provide high-quality, connected care services.
Key Responsibilities:
- Verify insurance/managed care plans for eligibility and document information in TxM and Athena.
- Use Athena to confirm eligibility and/or contact payers directly, documenting outcomes in patient accounts.
- Obtain prior authorizations for infusion plans in a timely manner to avoid treatment delays.
- Pre-certify patient infusions and injections by confirming insurance/managed care plan eligibility and prior authorization requirements.
- Advise staff of insurance plan updates.
- Authorize specialty pharmacy drugs for patients and maintain accounting through the PBM log system.
- High School graduate or equivalent.
- Prior medical office experience required.
- Prior Authorization Certified Specialist (PACS) preferred.
- Knowledge of insurance company/managed care organization constraints related to office procedures, visits, testing, and drug therapy.
- Prior authorization experience of one year strongly preferred.
- Strong customer service, interpersonal, and organizational skills.
- Ability to multitask and handle a fast-paced environment.
- Strong working knowledge of basic computer programs and good typing skills.
- Ability to plan, prioritize, and complete delegated tasks in a reasonable timeframe.
- Ability to work independently and as part of a team.
Total Rewards at Summit Health Inc
We value the critical role that health and wellness play in the lives of our team members and their families. Our benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages, and a 401k savings plan.
Equal Opportunity Employer
We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression, national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.
Safety Disclaimer
We care about the safety of our employees and applicants. We do not use chat rooms for job searches or communications. We will never request personal information via informal chat platforms or unsecure email. We will never ask for money or an exchange of money, banking, or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select company locations during regular business hours only.
