PRECERTIFICATION PRIOR AUTHORIZATION SPECIALIST, CENTRALIZED

Responsibilities

• Obtain precertification and/or prior authorization for patients' services, including radiologic testing, injections, chemotherapy, and/or radiation treatments.
• Contact patients to reschedule appointments if precertification and/or authorization cannot be obtained by 2:00 p. m. the day prior to their scheduled appointment.
• Review and verify accuracy of information and supporting documents for precertification and/or authorization numbers.
• Upload authorization numbers, time spans, and supporting documents into Mosaiq and HIS (Series) software upon verification of authorization.
• Use Quality Check List (QCL) in Mosaiq to monitor authorization requests and expiring authorizations.
• Document all actions in Mosaiq as the official medical record, following appropriate guidelines.
• Contribute to program development and other duties as assigned by the manager.

Requirements

• High school graduate preferred.
• Minimum (1) year prior administrative experience or equivalent, preferably in a hospital or medical office setting.
• Working knowledge of insurance and managed care.
• Excellent computer skills, including PC and Windows literacy, Microsoft Office applications, and various office machines.
• Prior use of medical office software database is preferred.

Qualifications

• Excellent communication and interpersonal skills.
• Ability to work effectively as part of a team and respond well to supervision.
• Self-motivated and proactive in tackling important issues, problems, and tasks.
• Attention to detail and ability to manage multiple tasks, meet deadlines, and be flexible in a variety of job roles.
• Flexibility in work schedule to adapt to operations and process management in a customer-focused business environment.