Prior Authorization Specialist at Mitchell Martin
Clark, NJ
About the Job
One of our clients is seeking for an Prior Authorization Specialist
Type: Contract
Schedule: Full Time, Monday- Friday 8am-4:30pm
Location: New Jersey
Responsibilities
The Prior Authorization Specialist is responsible for all aspects of the prior authorization process
Responsibilities include obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, coordinating patients' appointments/orders, collecting all the necessary documentation, contacting the patient for additional information and completion of the required prior authorization
The incumbent is responsible for documenting the appropriate information in the patient's record
The following duties are not intended to serve as a comprehensive list of all duties performed by all associates in this classification
Listed are duties intended to provide a representative summary of the major duties and responsibilities
Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties
Greet and assist patients professionally and courteously in person or on the phone to provide each patient assistance with insurance authorizations
Appropriately prioritize workload to ensure the most urgent cases are handled in a timely manner according to urgency
Obtain authorization via payer website or by phone and follow up regularly on pending cases
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
Communicate with patients, clinical partners, patient service representatives, and others as necessary to facilitate authorization process
Initiate appeals for denied authorizations at the provider's request
Coordinate and provide information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits
Answer providers, staff, and patient questions surrounding insurance authorization requirements respond to clinic questions regarding payer medical policy guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Contact patients to discuss authorization status
Document clearly all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
Review and update, as necessary, patient information including patient's demographics, emergency contact and insurance information in the Practice Management system
Monitor and retrieve voice messages daily from appropriate voicemail boxes
Other duties as assigned
Environmental hazards may be unpredictable including exposure to communicable diseases and biohazards
In that all associates contribute to the overall growth and development of La Red Health Center, Inc., it is occasionally necessary for associates to perform tasks that are not specifically indicated in their position descriptions
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
High school diploma or GED required
Minimum of two years' experience in medical billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicaid, Medicaid Managed Care, Medicare, Medicare Advantage Care Plans, HMO's and PPO's
Computer proficiency with Microsoft Outlook, Word, Excel required
Demonstrate and apply knowledge of medical terminology
Understanding of payer medical policy guidelines to manage authorizations effectively
Proficient use of CPT and ICD-10 codes
High proficiency of general medical office procedures
Knowledge of online insurance eligibility systems
Knowledge of medical center practices
Knowledge of EMR system, medical record documentation requirements and state/federal laws related to the release of health care information
Knowledge of HIPAA regulations
Skill in solving practical problems
Excellent phone etiquette
Excellent customer service
Ability to accept, interpret and implement orders from the qualified professionals on the team
Ability to communicate effectively and develop rapport with patients and families to facilitate implementation of a care plan
Ability to remain calm when emergencies occur
Ability to manage time effectively
Maintain a level of productivity suitable for the department
Computer use, and proficiency required
Involves standing, walking, kneeling, bending, grasping, manipulating and squatting and lifting (up to 50 pounds)
Walking or standing may be more than two (2) hours per day
Must be able to work in a standard medical office setting including use of a computer, and standard office equipment
Must have ability to read computer screens, printed materials and hearing and speech to communicate in person as well as over the phone
Must be able to attend meetings at various sites when required
Benefits
Wide range of standard office equipment
Please email: kylie.dilalla@hcmmi.com
#LI-KD1
Type: Contract
Schedule: Full Time, Monday- Friday 8am-4:30pm
Location: New Jersey
Responsibilities
The Prior Authorization Specialist is responsible for all aspects of the prior authorization process
Responsibilities include obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, coordinating patients' appointments/orders, collecting all the necessary documentation, contacting the patient for additional information and completion of the required prior authorization
The incumbent is responsible for documenting the appropriate information in the patient's record
The following duties are not intended to serve as a comprehensive list of all duties performed by all associates in this classification
Listed are duties intended to provide a representative summary of the major duties and responsibilities
Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties
Greet and assist patients professionally and courteously in person or on the phone to provide each patient assistance with insurance authorizations
Appropriately prioritize workload to ensure the most urgent cases are handled in a timely manner according to urgency
Obtain authorization via payer website or by phone and follow up regularly on pending cases
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
Communicate with patients, clinical partners, patient service representatives, and others as necessary to facilitate authorization process
Initiate appeals for denied authorizations at the provider's request
Coordinate and provide information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits
Answer providers, staff, and patient questions surrounding insurance authorization requirements respond to clinic questions regarding payer medical policy guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Contact patients to discuss authorization status
Document clearly all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
Review and update, as necessary, patient information including patient's demographics, emergency contact and insurance information in the Practice Management system
Monitor and retrieve voice messages daily from appropriate voicemail boxes
Other duties as assigned
Environmental hazards may be unpredictable including exposure to communicable diseases and biohazards
In that all associates contribute to the overall growth and development of La Red Health Center, Inc., it is occasionally necessary for associates to perform tasks that are not specifically indicated in their position descriptions
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
High school diploma or GED required
Minimum of two years' experience in medical billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicaid, Medicaid Managed Care, Medicare, Medicare Advantage Care Plans, HMO's and PPO's
Computer proficiency with Microsoft Outlook, Word, Excel required
Demonstrate and apply knowledge of medical terminology
Understanding of payer medical policy guidelines to manage authorizations effectively
Proficient use of CPT and ICD-10 codes
High proficiency of general medical office procedures
Knowledge of online insurance eligibility systems
Knowledge of medical center practices
Knowledge of EMR system, medical record documentation requirements and state/federal laws related to the release of health care information
Knowledge of HIPAA regulations
Skill in solving practical problems
Excellent phone etiquette
Excellent customer service
Ability to accept, interpret and implement orders from the qualified professionals on the team
Ability to communicate effectively and develop rapport with patients and families to facilitate implementation of a care plan
Ability to remain calm when emergencies occur
Ability to manage time effectively
Maintain a level of productivity suitable for the department
Computer use, and proficiency required
Involves standing, walking, kneeling, bending, grasping, manipulating and squatting and lifting (up to 50 pounds)
Walking or standing may be more than two (2) hours per day
Must be able to work in a standard medical office setting including use of a computer, and standard office equipment
Must have ability to read computer screens, printed materials and hearing and speech to communicate in person as well as over the phone
Must be able to attend meetings at various sites when required
Benefits
Wide range of standard office equipment
Please email: kylie.dilalla@hcmmi.com
#LI-KD1