Prior Authorization Specialist

6 days ago


Indianapolis, Indiana, United States Health & Hospital Corporation of Marion County Full time
Job Summary

As a Prior Authorization Coordinator at Health & Hospital Corporation of Marion County, you will play a crucial role in ensuring seamless healthcare services for our patients. Your primary responsibility will be to utilize a database of prior authorization and utilization data to obtain prior approvals for services provided by our organization.

Key Responsibilities

Utilize a database of prior authorization and utilization data to obtain prior approvals for services provided by the organization
Develop an intricate knowledge of the specific characteristics of each insurance plan and their contact personnel to assist in job function
Submit prior authorization requests through telephone contact, form completion, and fax communication with third-party payers and their representatives
Participate in the development and maintenance of databases specifying the precise prior authorization requirement for each client we serve
Submit the prior authorization request for each client assigned who requires a prior authorization
Communicate the outcome of the prior approval activity on a routine basis to the organization's administration and to the clinical areas
Participate in the development and maintenance of a system of tracking and managing denials of claims. Communicate this information on a routine basis to administration staff and to the clinical areas
Determine client insurance eligibility through web-based applications
Communicate data with clinical staff to ensure that services are provided within the parameters of the Prior Authorization and/or additional prior authorization requests are completed as needed
Compile data to trend identified issues with Prior Authorization for process improvement
Enter prior authorization data into appropriate systems
Participate as a member of the team assigned to manage the billing and claim affairs of the organization. Alerts this team and the supervisor of issues that arise in the course of this data development
Assist those staff assigned to claim payment functions to facilitate the efficient payment of claims
Performance Improvement-focused to facilitate the development of progressively more sophisticated and efficient prior authorization, billing, and claims processes
Designs custom reports and documentation utilizing appropriate software applications
Develops advanced computer skills to facilitate the development of databases, spreadsheets, and the utilization of other web-based applications
Reviews new bulletins and other sources of information and informs management of any updates or changes
In response to the changing nature of reimbursement in our industry, assists management in developing procedures for change
Communicates effectively with internal and external contacts

Requirements

High school diploma or equivalent (GED)
Bachelor's degree preferred
Minimum of 1 year of experience in a healthcare setting
Minimum of 2 years of experience with prior authorizations, billing, or related field

Competencies

Production / Accuracy
System / Software Applications

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana, and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana.

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