Medical Prior Authorization Specialist - Hybrid

We need to output HTML fragment with sections: headings

for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections if posting has real specific content. We need to parse the posting. Content includes: - Who We Are (company description) maybe "About the role"? Actually "Who We Are" is company description. Could be "About the role"? The instruction: use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can map sections accordingly. We need to decide which sections have content. From posting: - "Who We Are AC3 was founded..." => could be "About the role"? Actually "About the role" is about the job, not company. But we could use "About the role" for description of role? There's a "POSITION SUMMARY:" which describes role. So we can put that under "About the role" heading. - "Essential Function And Job Responsibilities" => Responsibilities. - "Position Requirements" => Requirements (or Qualifications). Could be both. - "WORK LOCATION:" maybe schedule? Not exactly. It's location/hybrid remote. Could be under "Schedule"? Not exactly. There's no explicit pay or benefits aside from "WHY WORK AT AC3?" which lists benefits: medical, dental, vision, employer paid life insurance, long/short-term disability, above average PTO, wellness program, biometrics, mental/physical wellness support, financial wellness counselors, employee assistance, company-matched 401k. That's benefits. - No explicit pay or schedule details besides "full-time hybrid/remote position; required onsite training and combination of remote and onsite work schedule." That's schedule info (hybrid/remote). So we could include Schedule section. - Pay: not mentioned. So we should NOT include Pay section. - Skills: maybe we can extract from requirements: "Proficient in Microsoft Office preferred", "Working knowledge/experience in electronic medical records", etc. Could be Skills section. - Qualifications: maybe same as Requirements. We need to avoid duplication. Could combine Requirements and Qualifications? But instruction: prefer few substantive sections over many thin ones. So we could have sections: About the role, Responsibilities, Requirements (including qualifications and skills), Benefits, Schedule. We must not repeat job title as heading. Not include Job ID etc. We must preserve all substantive information; do not invent or summarize away detail. So we need to include details from each section. We need to use

• for any list of duties/requirements/benefits, and

  for prose. We need to remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning, duplicated lines, application instructions. There's none obvious besides maybe "Learn more at www.ac3health.com" which is not boilerplate but maybe considered navigation? It's a link to learn more; could be considered navigation? Probably we should remove it as it's not substantive job info. Also "PI287028416" at end is likely Job ID; drop it. We need to keep all substantive info: company mission, position summary, responsibilities list, requirements list, work location details, why work at AC3 benefits. We need to format. Let's extract: Company description: "Who We Are AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way. That’s what motivates us. We’re looking for passionate, driven innovators to join our mission. If you thrive on challenge, love taking action, and get up every day ready to make a difference, apply now." But we should not include "apply now" as it's application instruction. Remove that sentence? The instruction says remove application instructions. So we should cut "apply now." Also "Learn more at www.ac3health.com" remove. Thus company description: "Who We Are AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way. That’s what motivates us. We’re looking for passionate, driven innovators to join our mission. If you thrive on challenge, love taking action, and get up every day ready to make a difference," maybe we keep up to "ready to make a difference," but that's still encouraging application. Safer to remove the last sentence entirely. Keep earlier part. Thus: "Who We Are AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way. That’s what motivates us. We’re looking for passionate, driven innovators to join our mission." Now Position Summary: "POSITION SUMMARY: The Prior Authorization Specialist (also called “preauthorization” and “precertification”) obtains approval for health care services or medications before care is provided. This position works closely with clients, insurance payers, providers, clinical staff, and patients to evaluate whether services are medically necessary and covered under the patient’s health plan. The Prior Authorization Specialist is responsible for obtaining authorizations for radiology exams, radiation oncology services, radiation therapy, procedures, and chemotherapy drugs. Previous radiation oncology (RadOnc) experience is strongly preferred, with knowledge of radiation oncology treatment workflows, terminology, and payer authorization requirements. The position is also responsible for accurately documenting and entering required information into applicable systems." We'll put that under About the role. Responsibilities: list from "Essential Function And Job Responsibilities". Each bullet is a sentence. We'll convert to

  • . List items: - Understanding of insurance requirements for prior authorization, including requirements specific to radiation oncology services and treatments. - Understanding of payer processes (website, fax, contact number) to submit appropriate authorization request - Understanding of insurance billing procedures and practices - Finding and understanding clinical information from EMR regarding services to be rendered - Contacting payers to obtain prior authorization - Following policy and procedures on treatment therapies and substitutions - Advising providers and their clinical staff when issues arise relating to obtaining prior authorization - Navigating and using national medical guideline tools - Verifying that all insurance requirements have been met before noting approvals - Following the workflow process on all pending cases - Serving as primary contact with outside facility request with our clients - Responding to all client emails and calls within the agreed upon policy timeframe - Noting and applying all authorization correspondence in both PM and EMR systems - Maintains the practices and principles set forth by AC3 leadership with a strong commitment to service, excellence, and quality. - Maintains professional behavior, confidentiality, and discretion always, along with the ability to work with all levels of staff with a confident and professional demeanor. - Follows HIPPA rules and regulations. Note: Some items start with verb, some are statements. Keep as is. Position Requirements: list: - High school diploma or equivalent (GED). - Prior radiation oncology (RadOnc) experience. - Medical office experience/medical terminology preferred. - Accurately maintains and adheres to all safety rules and regulations. - Must be detail oriented and have problem solving abilities. - Proficient in Microsoft Office preferred. - Working knowledge/experience in electronic medical records and/ or other medical software if applicable. - Must possess the ability to work with patients and family members in a confident, respectful, and socially professional manner. - Must rely on experience and judgment to plan and accomplish goals. - Excellent communication and organizational skills with the ability to work in a fast-paced environment; prioritize tasks and workloads. - Performs other duties as assigned. We could split into Requirements and Skills. But we can combine into Requirements section. Benefits: from "WHY WORK AT AC3?": - ongoing training, support, and a work culture like no other. - Full-Time Team Members medical, dental and vision health and wellness benefits - employer paid life insurance - long and short-term disability policies - above average paid time out plan (typo: paid time out? likely paid time off) - comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support. - access to company sponsored financial wellness counselors - employee assistance services - opportunity to enroll in our company-matched, 401k plan. We'll list as bullet list. Schedule: from "WORK LOCATION:": - This is a full-time hybrid/remote position; meaning, there will be required onsite training and the combination of a remote and onsite work schedule. - The ideal candidate will reside within a 30-mile radius of the office located in South Bend, IN. - Work is completed in a general office environment, sedentary in nature but may require standing and walking for up to 10% of the time. - The work environment is favorable with adequate lighting and temperature, and no hazardous or unpleasant conditions caused by noise, dust, etc. - Must be able to operate standard office equipment and keyboards. We'll put under Schedule. Now we need to output HTML fragment with

    headings and content. We must not include any extra text outside HTML. Let's craft:

    About the role

    Who We Are AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way. That’s what motivates us. We’re looking for passionate, driven innovators to join our mission.

    POSITION SUMMARY: The Prior Authorization Specialist (also called “preauthorization” and “precertification”) obtains approval for health care services or medications before care is provided. This position works closely with clients, insurance payers, providers, clinical staff, and patients to evaluate whether services are medically necessary and covered under the patient’s health plan. The Prior Authorization Specialist is responsible for obtaining authorizations for radiology exams, radiation oncology services, radiation therapy, procedures, and chemotherapy drugs. Previous radiation oncology (RadOnc) experience is strongly preferred, with knowledge of radiation oncology treatment workflows, terminology, and payer authorization requirements. The position is also responsible for accurately documenting and entering required information into applicable systems.

    Then Responsibilities:

    Responsibilities

    • Understanding of insurance requirements for prior authorization, including requirements specific to radiation oncology services and treatments.
    • Understanding of payer processes (website, fax, contact number) to submit appropriate authorization request
    • Understanding of insurance billing procedures and practices
    • Finding and understanding clinical information from EMR regarding services to be rendered
    • Contacting payers to obtain prior authorization
    • Following policy and procedures on treatment therapies and substitutions
    • Advising providers and their clinical staff when issues arise relating to obtaining prior authorization
    • Navigating and using national medical guideline tools
    • Verifying that all insurance requirements have been met before noting approvals
    • Following the workflow process on all pending cases
    • Serving as primary contact with outside facility request with our clients
    • Responding to all client emails and calls within the agreed upon policy timeframe
    • Noting and applying all authorization correspondence in both PM and EMR systems
    • Maintains the practices and principles