JOB SUMMARY (overview of job): The primary function of the Pre-Authorization Specialist position is to provide premier customer service to the patient, physician and their office staff by obtaining facility authorizations for patients scheduled at SPH. They will be required to verify insurance coverage and obtain insurance authorizations. The Pre-Authorization Specialist is required to maintain a working knowledge of all Managed Care Contracts as well as insurance requirements for authorizations, notifications or referrals. The Pre-registration Specialist position will utilize office equipment such as a scanner, credit card terminals and fax machine. They will be in communication with outside physician offices and ancillary departments within the hospital to complete an accurate patient record.
The Prior Authorization Specialist responsibilities may included, but are not limited to:
applying medical knowledge and experience for prior authorize requests;
performing detailed medical reviews of prior authorization request or assessment forms according to established criteria and protocols;
manage incoming authorization requests and inquiries via fax, computer, telephone, or mail;
maintain accurate documentation on all requests and documenting in the appropriate computer application;
Initiates and continues direct communication with health care providers involved with the care of the member to obtain complete and accurate information;
Serve as a resource to clients;
have the ability to complete additional duties as needed.
KNOWLEDGE/EXPERIENCE: Sufficient experience to demonstrate ability to accept responsibility as a Hospital and Clinic prior authorization representative. Knowledge of anatomy and physiology, medical terminology and disease processes.
EDUCATION: High school Diploma or an equivalent required.
Aptitudes: Ability to achieve cognitive, organization and emotional maturity to deal effectively with multiple tasks, stresses, deadlines, difficult situations and/or customers. Possesses interpersonal/communication skills necessary for effective, non-judgmental, and empathetic patient care and customer relations. Open to feedback, and open to a changing environment, which requires flexibility in scheduling and department assignments.