Ambulatory Nurse Specialist
23 hours ago
Atlantic Health System is seeking an experienced Ambulatory Nurse Specialist to join our team. As a key member of our Women's Health department, you will be responsible for coordinating and overseeing all obstetrical and gynecological authorizations with our CMA Prior Authorization Specialist.
Responsibilities:- Enter information on the PRA/SPECT Perinatal Risk Assessment & Single Point Entry Client Tracking system for the State of New Jersey.
- Initiate and manage the prior authorization process for all obstetrical patients and gynecological patients.
- Communicate effectively with internal departments and insurance companies to obtain necessary authorization.
- Gather and organize patient medical records, treatment plans, and other relevant documentation required for authorization.
- Ensure all documentation provided meets insurance company requirements and guidelines.
- Collaborate with providers to obtain additional information or clarification as needed.
- Schedule and facilitate peer-to-peer reviews between providers and insurance company medical directors.
- Document all communication and actions taken throughout the authorization process accurately and thoroughly.
- Monitor the progress of authorization requests and follow up as necessary to expedite approvals.
- Stay updated on changes in insurance policies, guidelines, and procedures related to prior authorizations.
- Provide support and guidance to providers and staff regarding prior authorization requirements and processes.
- Current NJ RN License
- Current BLS
- Women's Health Experience
- Knowledge of prior authorizations and medical necessity
- Strong understanding of medical terminology, procedures, and pharmaceuticals
- Excellent communication skills, both verbal and written, with the ability to effectively interact with insurance companies, healthcare providers, and patients
- Detail-oriented and organized, with the ability to manage multiple tasks and prioritize workload effectively
- Proficient computer skills, including experience with electronic medical records Epic systems and Microsoft Office Suite
- Ability to work independently and as part of a team in a fast-paced environment
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