Prior Authorizations Rep (30486)

Responsibilities

• Review EMR chart messaging and review schedules daily for upcoming surgical & in-office procedures
• Review chart documentations to ensure patient meets medical policy guidelines
• Prioritize authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Verify coverage and benefits and calculate any out-of-pocket portions due
• Contact patients to review any out-of-pocket portions due prior to surgery

Qualifications

• Minimum 1 year prior authorization experience
• Understanding of payer medical policy guidelines to manage authorizations effectively
• Proficient use of CPT and ICD10 codes
• Detail-oriented and above-average organizational skills
• Plans and prioritizes to meet deadlines
• Able to multitask and remain focused while managing a high volume, time-sensitive workload
• Urology experience helpful

Physical Requirements

• Requires sitting for extended periods
• Some bending, stretching, and stooping required
• Manual dexterity enough to use a keyboard and calculator
• Normal range of hearing and vision and verbal communication is required
• Use of a telephone is required

Performance Requirements

• Knowledge of billing and insurance practices and procedures as well as regulations including Medicare, Medicaid, and third-party insurance companies including managed care contracts
• Knowledge of current ICD-10 and CPT codes is required
• Strong communication skills are required