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Prior Authorization Specialist

OrthoArizona
Peoria, USA
Full-time
Entry
Onsite
Discovered 1 months ago

Full Job Posting

  • Verify insurance authorization requirements for ordered services/ procedures.
  • Reviews documentation or contacts the provider when necessary to supplement the order to prove medical necessity.
  • Ensures appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.
  • Submits all authorizations with correct CPT and diagnosis codes.
  • Cross-references the procedure tasked against the doctor’s orders to ensure all services are submitted correctly.
  • Enters any authorization numbers and expiration dates into the EMR for proper claim processing.
  • Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
  • Monitors and resolves the status of problem authorizations.
  • Faxes outgoing imaging orders to corresponding facilities and follows the order to ensure the patient is scheduled.
  • Maintain medical records in accordance with practice policies and procedures.
  • Estimates prepay amounts due for services and collects co-insurance, copays, deductibles or estimates self-pay rates; prepares daily batch, deposits, etc.
  • *Using state or federally regulated websites may require personal login credentials.
  • Excellent customer / patient service. Knowledge of medical terminology.
  • Working knowledge of computer programs.
  • Excellent written and verbal communication skills.
  • Understand/Perform training on practice management software.
  • Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.
  • Ability to communicate effectively on the telephone.
  • Ability to make decisions and solve problems.
  • Working knowledge of health insurance plans including reading plan requirements.
  • Follow all Standard Operating Procedures.
  • High School diploma or GED.
  • Minimum of 2 years of experience in healthcare administration or related field.
  • Strong organizational and communication skills.
  • Ability to work independently and as part of a team.
  • Knowledge of medical terminology and insurance authorization processes.

Full Time Benefits

  • Robust paid time off package including, sick time, holidays, & paid time off!
  • Medical with multiple different plan options.
  • Health Savings account + company contributions.
  • Dental & Vision Insurance.
  • 401(k)
  • Pet Discount Plan.
  • ID Theft Protection & Legal Assistance.

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