Prior Authorizations Specialist

About the Company:

Leading Healthcare is seeking a Prior Authorizations Specialist to serve in our Primary Care Clinics. We are a fast-growing Medical Group that serves the community through our Medical Clinics, Post-Acute Care Facilities, and Hospitals. We offer competitive pay and financial incentives for achieving high quality care metrics.

If you’re ready to join our team and lead the mission in helping our patients live the healthiest lives, please apply now.

The Prior Authorization Specialist is responsible for all aspects of the prior authorization process for our Internal Medicine and Psychiatric clinics.

Responsibilities include:

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and prior authorization requirements.
• Review chart documentation to ensure patient meets medical policy guidelines.
• Prioritize incoming authorization requests according to urgency.
• Obtain authorization via payer website or by phone and follow up regularly on pending cases.
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
• Initiate appeals for denied authorizations.
• Respond to clinic questions regarding payer medical policy guidelines.
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status.
• Receiving and processing medical records requests.

Other duties as assigned.

Job Type: Full-time

Starting Pay: $19.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision Insurance
• Paid time off.
• Long- Term Disability
• Life Insurance
• 401(k)

Schedule:

• 8-hour shift
• Day shift
• Monday to Friday
• No weekends

Work Location: Goodyear Clinic

Minimum Qualifications:

• Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
• Proficient use of CPT and ICD-10 codes
• Excellent computer skills including Excel, Word, and Internet use.
• Detail oriented with above average organizational skills.
• Plans and prioritizes to meet deadlines.
• Excellent customer service skills; communicates clearly and effectively.
• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.
• Insurance verification: 1 year (Preferred)
• Prior authorization: 1 year (Preferred)
• Medical Records experience (Preferred)