Prior Authorization Specialist
Description
CORNERSTONE FAMILY HEALTHCARE is seeking a Prior Authorization Specialist to join our dynamic team in MIDDLETOWN, NY.
WORK LOCATION(S): MIDDLETOWN, NY
STATUS: Full-time
Cornerstone's Mission
CORNERSTONE FAMILY HEALTHCARE is a non-profit Federally Qualified Health Center committed to providing high-quality, comprehensive primary and preventive healthcare services to all individuals, regardless of their ability to pay. Since 1968, we have been dedicated to serving the communities we serve, focusing on underserved populations and those without access to healthcare.
Job Duties
Assists patients in obtaining prior authorizations for treatment requiring insurance pre-authorization.
Handles all prior authorization submissions to proper insurances.
Documents in EMR authorization status, actions, and outcomes.
Communicates with internal providers to obtain all required information for efficient prior authorization submission.
Has medical terminology knowledge, including ICD, CPT, procedure codes/names, and test names.
Notifies appropriate internal departments of necessary information, such as complaints or adverse event notifications.
Communicates and builds relationships with insurance carriers and servicing providers/facilities.
Schedules peer-to-peer meetings between CFH provider and insurance company for prior authorization denials.
Requests and prepares supporting documentation for medical necessity of services being authorized, such as medical records, labs, previous prior authorizations, appeals, denials, and prescriptions.
Sorts daily work queues and is accountable for identifying and processing daily tasks.
Performs initial insurance benefit verification and pre-surgical authorization for new OB/GYN or Podiatry surgical cases.
Advises providers and patients about changes or cancellations of surgical/procedural bookings.
Fields phone calls from staff and service providers and resolves inquiries related to prior authorizations.
Manages multiple authorization requests simultaneously.
Exemplifies excellent customer service with patients, visitors, and other employees, showing courtesy, friendliness, helpfulness, and respect.
Demonstrates respect for the capabilities, different cultures, and personalities of internal and external customers.
Maintains and ensures patient privacy and confidentiality.
Takes initiative to proactively assist others.
Maintains open and effective communication with providers and employees to ensure quality.
Requirements
Bilingual (English & Spanish)
At least one-year clerical experience in a health-related field
Knowledge of data entry
Pleasant telephone manner