Join our team who is committed to the delivery of the highest quality health care service. We are seeking a full-time Prior Authorization Specialist that is self-motivated, energetic, and a take charge individual.
Job Responsibilities:
Review scheduled appointments, verify insurance, and determine the need for prior authorization. Reschedule/pend/hold all scheduled appointments if prior authorization is required and not in effect
Work with providers to determine care plan and services to be provided under prior authorization
Submit all services that require prior authorization to insurance carrier either on-line or via FAX
Develop and maintain record of all submitted requests for prior authorizations.
Follow up on authorizations not received in a timely manner
When authorization is received, enter authorization information into Intergy and EHR
Notify patient that prior authorization has been received and schedule appointment
Notify provider that authorization is in place and what service(s) is approved. Provide Advance Beneficiary Notice information to provider and patient if needed
Monitor service(s) provided to be certain the billed service(s) matches the authorized service(s). Notify Manager if there are discrepancies
Develop and maintain a method to track prior authorization services and dates to eliminate risk of providing service(s) that exceed the limits of the authorization
Qualifications:
High school diploma or GED
Excellent oral and written communication skills.
Working knowledge of computers and office applications software
Proven working knowledge of the prior authorization process and related carrier requirements
Ability to relate well to people from diverse ethnic and cultural backgrounds
No Phone Calls Please. Qualified applicants may apply online, send resume to Sue Raymond, Vice President of Human Resources, Sixteenth Street Community Health Centers, 1337 S. 16th St., Milwaukee, WI 53204 or fax to 414-672-0413. Sixteenth Street Community Health Centers is an equal employment opportunity employer.