Prior Authorization Specialist
Essential Job Responsibilities/Expectations
Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values
- Answers telephone within three rings using good customer service skills to ascertain the nature of the call as needed.
- Uses proper telephone etiquette when receiving and transferring calls; speaks clearly and concisely. Exercises tact and diplomacy
- Maintains confidentiality in talking with patients, upholding policies and setting an example.
- Schedules and reschedules appointments if needed.
- Uses exceptional customer skills when speaking with insurance companies/patients and other internal departments
- Keeps work area neat, clear of clutter.
- Works in with iPas system and monitors communications needs to assure timely responses
- Monitors email throughout the day
- Demonstrates a willingness to assist coworkers when workloads require
- Timely management of prior authorization requests for all infusion services ordered through Florence and Seacoast Oncology and Hematology Offices
- Oncology and Hematology, radiology services as necessary, and other medical testing and procedures based on diagnosis and need
- Display advanced computer skills within programs such as Excel and Word and Internet use
- Review chart documentation to ensure patient meets medical policy guidelines
- Prioritize incoming authorization request according to urgency
- Obtain authorizations via payer website or by phone
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of ICD diagnosis and corresponding J codes or CPT codes for orders
- Contact patients to discuss authorization status and obtain additional information as needed
- Display ability to learn and retain basic medical terminology allowing proficient navigation and documentation within the electronic medical record
- Maintain knowledge of up to date payor specific programs to ensure appropriate authorization
- Assist with Cash Balancing procedures
- Other duties as assigned
- Knowledge of prior authorization process and it’s impact on the practice’s revenue cycle
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
- Basic understanding of oncology treatment approaches and radiology studies as relating to diagnosis and restaging
- Proficient use of J codes, CPT codes, ICD codes
- Excellent computer skills including Excel, Word, internet use, and electronic medical record systems
- Detail oriented with above average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills
- Clear and effective communication
- Ability to multi-task and remain focused while managing a high-volume, time sensitive workload
- Minimum of a High School Diploma/GED from an accredited school
- 2 years of experience in medical related field or completion of a medical based educational program preferred
- 2 years of medical prior authorization experience preferred
Physical Requirements: Refer to occupational Risk Assessment
Ability to lift up to 50 pounds and carry up to 25 pounds occasionally. Will involve some stooping, kneeling, crouching, pushing, pulling, with frequent standing and walking. Requires manual dexterity with ability to perceive size, shape, temperature, texture; auditory and visual accuracy required with attention to verbal abilities and color discrimination.
OSHA Task Category: III
Tasks that involve no exposure to blood, body fluids, or tissues. Category I tasks are not a condition of employment. The normal work routine of these positions involves no exposure to blood, body fluids, or tissues. Persons who perform these duties are not called upon as part of their employment to be potentially exposed in some other way. Tasks that involve handling of implements or utensils, use of public or shared bathroom facilities or telephones, and personal contacts such as hand shaking are Category 3 tasks.
Florence, SC, United States