FQHC Pre-Authorization Specialist

About the role

Pre-authorization Specialist is responsible for the patient registration process, infusion center admissions, co-pay cash collection, and financial arrangement issues. This position verifies third party payer accounts, pre-authorization and/or pre-certification requirements. The role involves interfacing with all private payers or their designees to obtain authorization for treatments, imaging, or lab studies and facilitates physician-to-physician peer reviews of questionable cases.

Additional responsibilities include ensuring assignment of appropriate codes and Diagnosis Related Group (DRG) codes, collecting quality statistical information, and ensuring timely follow-up and processing of all accounts. The position also performs charge data reconciliation of all infusion accounts and collects data for statistical and/or financial analysis. Ongoing communication and collaboration with the infusion team members and providing quality customer service are key aspects of this role.

This position supports organizational goals by participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation.

Responsibilities

• Patient registration and infusion center admissions
• Co-pay cash collection and addressing financial arrangement issues
• Verification of third-party payer accounts, pre-authorization, and pre-certification requirements
• Obtaining authorization for treatments, imaging, or lab studies from private payers or their designees
• Facilitating physician-to-physician peer reviews of questionable cases
• Assigning appropriate codes and Diagnosis Related Group (DRG) codes
• Collecting quality statistical information and ensuring timely follow-up and processing of accounts
• Performing charge data reconciliation of infusion accounts
• Collecting data for statistical and/or financial analysis
• Collaborating with infusion team members and providing quality customer service
• Participating in performance improvement efforts and supporting organizational goals

Requirements

• High school diploma or equivalent required
• Ability to read, write, and speak English is required
• 1-3 years of medical office experience, preferably in a healthcare setting
• Knowledge of medical or dental terminology preferred
• Knowledge of general computer and data entry functions required

Work Environment

• Potential exposure to hazards and risks of the hospital environment, including infectious disease and hazardous substances
• Requires reaching, stooping, kneeling, and crouching approximately 25% of the workday
• Frequent lifting of approximately 25-30 pounds; occasional lifting of 50-100 pounds with assistance

This position reports to the Infusion Medical Director or designee.

Benefits

• Generous Paid Time Off (PTO)
• Medical, prescription drug, dental, and vision insurance
• Retirement plans with employer contributions
• Short-term and long-term disability coverage
• Life and accidental death & dismemberment insurance
• Tuition reimbursement to support educational goals
• Flexible Spending Accounts (FSAs) for healthcare and dependent care
• Wellness programs
• Voluntary benefits, including pet insurance and more

Benefits offerings may vary based on position and are subject to eligibility requirements.