Prior Authorization Specialist - Healthpro Heritage, LLC

General Description

• Obtain Precertification/ Prior Authorization/Referrals for all Direct Bill facilities.
• Serves as a valuable resource to patients, families and direct providers, providing them with pertinent information regarding Prior Authorization.

Principal Responsibilities and Duties: These statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered a detailed description of work requirements that may be involved.

1. Responsible for working with the Verification Specialist to determine which residents insurance requires precertification/prior authorization/referrals.
2. Responsible for working with the Program Managers to determine what services need precertification/prior authorization/referrals.
3. Responsible for notifying the Program Manager when precertification/prior authorization/referral information is obtained and services can be provided.
4. Responsible for noting the precertification/prior authorization/referral information in the system for claims processing.
5. Responsible for reviewing Direct Bill resident files to be sure that necessary information is accounted for.
6. Responsible for the accurate and timely preparation and submission of reports required by management.
7. Responsible for the follow up concerning authorization request for services and any request for continuing services.
8. Other duties as assigned.

HealthPro Heritage is an Equal Opportunity Employer. We consider all qualified candidates for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by law. Our employment decisions, including those related to hiring, promotion, and compensation, are made based on individual qualifications, performance, and organizational needs.

Knowledege, Skills, Experience Required

1.  Requires experience with obtaining precertification/prior authorization/referral with Medicare replacement plans and other commercial payers.
2. Requires formal knowledge and understand of CPT and ICD-10 codes.
3. Basic understanding of requirements and regulations set forth by Medicare and other related agencies.
4. Must be extremely organized in order to ensure all visits are authorized and further authorization is obtained as needed.
5. Communications often deal with sensitive, confidential issues aimed at precertification/prior authorization/referrals.
6. Must be able to clearly communicate their expertise concerning any number of authorization issues, requiring advanced oral and written skills.
7. Detail and goal oriented
8. Works well independently while being a team advocate and working well with others
9. Ability to multi-task and manage daily task.