Job Description

GENERAL DESCRIPTION

The Authorization Specialist is responsible for calling insurance companies to obtain prior authorization and precertification for services, procedures and medications.

ESSENTIAL JOB FUNCTIONS

• Responsible for prior authorization and precertification of eligible medical services, procedures and medication.
• Ensure complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services.
• Call/navigate insurance websites for authorization requirements and obtain timely authorizations from various insurance companies.
• Communicate with insurance carriers, both internal and external customers and patients via phone or written correspondence.
• Update task in the system to include approvals, coinsurance, copay, deductibles and authorization requirements.
• Initiate appeals for denied authorizations.
• Prioritize incoming prior authorization and precertification requests according to urgency.
• Familiar with the practices and job duties at the Wolf River Clinic and all outlying clinics and is able and willing to work at these locations as needed.
• Communicate regularly with supervisor, keeping him/her apprised of all pertinent information and providing feedback.
• Ensure compliance for all regulatory requirements including OSHA, CLIA and HIPAA; immediately and accurately document and report occurrences to supervisor; and ensure compliance with all legal and regulatory requirements as outlined in the corporate compliance plan.
• Support and adhere to all company policies, procedures and management decisions; maintain confidentiality of patients medical information; and all confidential administrative related issues.
• Demonstrate dependability in attendance, punctuality in reporting for work and initiative in completing a full work schedule; meeting or exceeding all established deadlines and utilizing all resources and supplies efficiently and appropriately.
• Demonstrate the ability to concentrate during the course of the day.
• Display a positive outlook with a helpful, constructive manner when working with other employees.
• Demonstrate superior patient relations and interpersonal skills; demonstrate an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public using tact, sensitivity and sound judgment; promote a positive work environment and contribute to the overall efforts of the department and the company.

POSITION REQUIREMENTS

• Completion of a nursing program from an accredited school is required.
• Current Pharmacy Technician (CPhT) is required.
• Two years of clinical experience, preferably in a urology practice is required.
• Excellent oral and written communication, interpersonal, problem solving and organizational skills are required.
• Occasional overtime, evening and weekend work is required.

ESSENTIAL PHYSICAL REQUIREMENTS

• Requires prolonged sitting, some bending, stooping and stretching, or performing other work requiring moderate physical exertion.
• Capacity to maintain physical activity over prolonged periods of time (stamina).
• Able to see for the purpose of reading information received in different formats including but not limited to paper, computer, reports, bulletins and manuals.
• Able to hear for work-related purposes.
• Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
• Able to lift up to a minimum of 25 pounds.

ESSENTIAL ENVIRONMENTAL CONDITIONS

• Work is generally performed under normal office working conditions.
• Normal level of visual strain.
• Ability to cope with stress caused by public interaction, multiple demands and extraneous noises.
• Possible exposure to contagious diseases.

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