Overview
Prior Authorization Specialist Jobs in Denison – Iowa – USA at Crawford Country
Essential Duties and Responsibilities:
Review chart documentation to ensure patient meets medical policy guidelines to support the order/procedure.
Prioritize incoming authorization requests according to urgency
Performs initial insurance benefit verification through payer website or Accu Reg system
Obtain procedural authorization via payer website or by phone and follow up regularly on all pending cases
Communicate with clinical areas on information needed and updates as to approval or denial of authorization
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
Initiate appeals for denied authorizations
Respond to clinic questions regarding payer medical policy guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Contact patients to discuss authorization status if needed
Answers department telephones appropriately and handles routine questions involving prior authorization issues
Demonstrates ability to use EMR system to locate and upload medical record information
Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies.
Customer service skills for interacting with patients regarding authorizations including communicating with patients and family members ofdiverseages and backgrounds
Consistently reports to work at the scheduled time in a punctual manner and at the assigned job location.
Regularly attend monthly staff meetings and continuing educational sessions as requested.
Attends all requiredSafety Trainingprograms and can describe his/her responsibilities related to general safety, department/service safety and specific job-related hazards.
Follows the Hospital Exposure Control Plans/Bloodborne and Airborne Pathogens.
Demonstratesrespectand regard for the dignity of all patients, families, visitors and fellow employees to ensure a professional, responsible and courteous environment.
Promotes effective working relations and works effectively as part of a department/unit team inter- and intra- departmentally to facilitate the department’s/unit’s ability to meet its goals and objectives.
Non-Essential Duties and Responsibilities:
Perform other duties as assigned
Professional Requirements
Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
Basic understanding of human anatomy, specifically musculoskeletal
Proficient use of CPT and ICD-10 codes
Excellent computer skills including Excel, Word, and Internet use
Detail oriented with above average organizational skills
Plans and prioritizes to meet deadlines
Excellent customer service skills; communicates clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
Complete annualeducationrequirements.
Maintain patient confidentiality at all times.
Report to work on time and as scheduled.
Wear identification while on duty.
Maintain regulatory requirements, including all state, federal and local regulations.
Represent the organization in a positive and professional manner at all times.
Comply with all organizational policies.
Conduct oneself as a professional in accordance with PRIDE values.
Participate in performance improvement and continuous quality impr…
Title: Prior Authorization Specialist
Company: Crawford Country
Location: Denison – Iowa – USA
Category: Healthcare, Administrative/Clerical
