Prior Authorization Specialist- Remote -Ft

REMOTE POSITION

Essential Functions and Basic Duties

Position Specific Performance Expectations:

o Obtains prior authorizations/pre-certification per payer requirements for physician ordered procedures and

ensures authorization information is documented appropriately in the system.

o Verifies physician orders, authorization and demographic information are all complete prior to sending to

the hospital scheduling department.

o Communication is maintained with providers, clinical staff and patients in relationship to authorization

status.

o Works and assists the billing department in researching and resolving rejected, incorrectly paid and denied

claims as requested

o Remains current with insurance requirements for prior authorization’s and provides education within the

department and clinical staff on changes.

o Maintain efficient tracking of all pending authorizations to ensure timely resolution.

o Performs other duties as assigned.

Organization Wide Performance Expectations:

o Demonstrates commitment to performing according to the CHOICE values of MRH and representing the

organization in a positive and professional manner.

o Maintains patient confidentiality at all times.

o Upholds regulatory requirements to ensure continual compliance with departmental, hospital, state and

federal regulations and policies.

o Follows all policies and procedures to ensure a safe environment for patients, public and staff.

o Completes annual education, training, in-service, and licensure/certification requirements; attends

departmental and organizational staff meetings or reads meeting minutes.

o Reports to work on time and as scheduled; completes work within designated timeframes.

o Establishes and maintains effective verbal and written communication and good working relationships with

all patients, staff and vendors.

o Utilizes initiative; strives to maintain steady level of productivity; self-motivated; manages activity and

time.

o Actively participates in departmental and facility performance improvement and continuous quality

initiatives

Qualifications

Minimum Requirements:

o Must be at least 16 years of age (21 for driving positions)

o Must be able to legally work in the United States

o Must be able to pass a background check

o Must be able to pass a drug screen and breath alcohol test (if applicable)

o Must complete employee health meeting

Education/Licensure/Certification:

o High School Diploma or equivalent preferred

Knowledge Preferred:

o Past knowledge of CPT, HCPCS and ICD-10 codes

o Past knowledge of Medical Terminology

Experience:

o Past experience in the prior authorization process

o Past experience with Microsoft Office to include Word, Excel and Power Point helpful

o Data entry experience

Skills/Abilities:

o Detailed oriented

o To be flexible and able to multi task.

o Bilingual Optional

Position Classification: Non-exempt

Compensation Range: $20.96 to $30.39

Benefits: Medical, Dental, Life, Retirement, Paid Time Off