Prior Authorization Specialist

Essential Functions

• Responsible for authorizations in multi-provider practice.
• Obtain patient insurance information and contact insurance carriers online or by phone to verify requirements.
• Research clinical information from medical record needed to obtain prior authorizations from insurance companies or patient assistance programs.
• Communicate authorizations to patients and physicians explaining approvals or denials for medication when needed.
• Field any phone calls and emails related to authorizations.
• Establish relationships with drug companies.

Competencies

• Excellent organizational and problem-solving skills
• Demonstrates well developed interpersonal/communication skills necessary to interact effectively with internal and external customers
• Able to evaluate a variety of patient situations and make timely decisions
• Ability to work in fast-paced, deadline-oriented environment, with minimal supervision, with the ability to meet deadlines is a must with constant communication required
• Strong computer skills, including basic keyboarding, experience with Microsoft Office software (Outlook, Work, Excel)
• Ability to support and understand authorization processes
• Knowledge and/or willingness to understand insurance guidelines and requirements to successfully complete prior authorizations/pre-determinations

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Position Type/Expected Hours of Work

Full Time / Monday – Friday

Travel

None

Work Authorization/Security Clearance

Must be authorized to work in the US for any employer

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Background Check Requirement

As a condition of employment, a complete background investigation will be conducted based on the rules of the specific State in which the employee is hired. Typically, the state investigative process includes a state and federal background check. In addition, a drug screen will be required. TB testing will also be required for all patient-facing roles.

EEO Statement

US Digestive Health is an Equal Opportunity Employer. USDH does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, genetic information, or any other consideration protected by federal, state or local laws. Our commitment to equal employment opportunities applies to all persons involved in our operations and prohibits unlawful discrimination by any employee, including supervisors and coworkers.

Disclaimer

This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice. The list of job responsibilities, skills, duties, requirements, and the like is not exhaustive, rather it is illustrative of the current essential functions required for the position.