Prior Authorization Associate

Job Summary

Responsible for accurately authorizing referrals prior to patient appointments. Utilizes Epic Referral Work Queues, Experian Real Time Authorization (RTA), phone, payer websites and fax to complete prior authorizations for imaging and specialty services. Communicates authorization updates to appropriate departments. Verifies all pertinent clinical information is submitted in order for authorization to be processed accurately. Documents all information within the referral record and chart in Epic to include approvals, denials, peer-to-peers and pending authorizations.

Minimum Qualifications

• Minimum Education: High School Diploma or Equivalent
• Minimum Years of Experience: 6 months of referral and/or authorization experience
• Substitutable Education & Experience: None.
• Required Certifications/Licensure: None.
• Required Training: Strong Medical Terminology and Insurance Knowledge; Knowledge of ICD-10 and CPT Coding

Duties & Responsibilities

• Prioritizes the referral process and ensures authorization is an integral part of the process.
• Maintains authorization volume and quality standards set monthly.
• Reviews patient charts in Epic, submits appropriate clinical information for authorization to the correct payer/third party vendor, and obtains final determination from payer.
• Utilizes Experian RTA system to obtain authorization and verifies authorization completion within system.
• Communicates all necessary authorization updates and status changes to the appropriate department(s).
• Collaborates with PN practices to ensure providers/clinical staff complete required tasks to obtain payer authorization.
• Works with LMC departments and insurance companies to provide quality care to LMC patients through the authorization process prior to patients' date of service.
• Escalates difficult issues, problems, questions and process improvement suggestions to management.
• Participates in team problem solving activities, focuses on production and quality.
• Performs other duties as assigned.

Benefits

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

• Day ONE medical, dental and life insurance benefits
• Health care and dependent care flexible spending accounts (FSAs)
• Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
• Employer paid life insurance – equal to 1x salary
• Employee may elect supplemental life insurance with low cost premiums up to 3x salary
• Adoption assistance
• LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
• Tuition reimbursement
• Student loan forgiveness

Equal Opportunity Employer

It is the policy of Lexington Health to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. Lexington Health strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. Lexington Health endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.