Job Description

Position Title: Prior Authorization Specialist

Supervisor: Prior Authorization Manager

FLSA Status: Non-Exempt

Mission:

To provide our patients and community the most innovative and breakthrough treatment options to improve overall health and wellness.

Values:

Innovation

Integrity

Patient Experience

Teamwork

Job Summary:

Working under the direction of the Prior Authorization Manager, the Prior Authorization Specialist supports the business office by reviewing patient insurance information to determine if treatments, procedures, or medications require prior authorization and preparing and submitting requests to insurance companies with necessary documentation. Duties of this role include, but are not limited to:

• Manages and processes Prior Authorizations including, but not limited to, Medicare, Commercial, Medicaid, and Worker’s Compensation for injections, procedures, and other prior authorization needs.
• Identifies insurance coverage and coordinates with patients on their pre-procedure requirements.
• Maintains working knowledge of insurance prior authorization requirements, policies, and guidelines.
• Effectively communicates with insurance companies, physicians’ offices, outside vendors, and patients.
• Acts as a resource for providers in determining patient authorization needs.
• Manages and processes authorization denials and appeals.
• Processes prior authorization paperwork.
• Facilitates prior authorization projects and tracks metrics as required.
• Cross-trains on other duties, including billing, as required.

Supervisory Responsibility:

• This position has no supervisory responsibilities. 

Qualifications:

• High School Diploma or GED required.
• Associate’s or Bachelor’s degree preferred.
• Minimum of 1-year of prior authorization experience required in healthcare environment.
• Medical terminology preferred (CPT/HCPCS, ICD-10 Codes, Procedures, etc.).
• NextGen experience preferred.

Skills & Abilities:

• Detailed oriented with ability to manage multiple priorities and work in a highly active environment.
• Strong verbal and written communication skills.
• Strong knowledge of insurance and eligibility.
• Ability to problem solve.
• Proficient computer and business skills.
• Self-directed, reliable, consistent.
• Ability to multi-task.
• Ability to work independently and with a team.
• Ability to be a professional representative of the company.
• Ability to follow directives as presented by your supervisor.
• Ability to follow company policies and procedures.
• Ability to abide by all HIPAA privacy laws.

Work Environment:

While performing the duties of this job, the employee regularly works in an office setting located in Edina, MN.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to grasp or handle objects, tools, or controls; reach with hands and arms; stoop, kneel, or crouch; talk or hear. The employee must be able to sit for 90% of the day and occasionally lift or move up to 10 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Compensation & Work Schedule:

• Full-time: 40 hours/week.
• Non-Exempt.
• Day Shift: Monday – Friday, 8:30AM – 5:00PM (*hours will vary during training period).
• No evenings or weekends.
• A competitive benefits package including medical, dental, vision, life, and disability insurance, 401(k), PTO time, paid holidays, and HSA plan is offered.

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