Prior authorization Specialist

About the role

Prior authorization Specialist position available for 06 months in Plano, Texas 75024.

Responsibilities

• Affiliate with multiple levels of appeal in the event of initial coverage denial.
• Forward authorized confirmation for procedure to designated patient provider.
• Provide in-servicing to new patient providers surrounding the pre-authorization process.
• Manage multiple cases simultaneously within specific time frames.
• Follow all policies and procedures related to performing the job role.
• Verify benefits, complete authorization requests promptly.
• Timely follow up for requested authorizations.
• Audit required clinical documents for completeness and accuracy.
• Obtain authorization for the facility, equipment and physician to perform various procedures from the insurance carrier.
• Work with key provider contacts to obtain required clinical information for authorizations.
• Work with respective carrier's utilization review department to obtain appropriate authorizations.
• Process appeal for denied requests within established guidelines when necessary.
• Train patients and their designated providers on pre-authorization processes and requirements, in person or by phone.
• Work individually and in a team environment to educate assigned Field Territory Managers and Clinical Specialists.

Requirements

• High School Diploma required, Associate Degree a plus.
• Minimum of 2 plus years experience in a utilization (medical approval) environment or similar work experience.
• Knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.
• Experience in medical device or DME Billing a plus.
• Proficient with Microsoft Office (Word & Excel specifically).
• Medical billing software experience a plus.
• Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding).
• Able to accurately meet required time frames/deadlines.
• Able to work as a team player and share workloads with other team members.
• Excellent verbal and written communication skills.
• Able to train/present concepts to others.