[Hiring] Prior Authorization Specialist @BMC Company 100
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Role reputed company
Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including a broad reputed company of requests for inpatient, outpatient and ancillary services.
• Adheres to policies and procedures to reputed company with performance and compliance standards.
• Maintains reputed company knowledge of network resources for referral and linkage to member’s and provider’s needs.
• Authorizes certain specified services under the supervision of the manager according to departmental guidelines.
• Forwards specified requests to the clinician for review and processing.
• Answers ACD line calls from providers and other departments and redirects as needed.
• Coordinates reputed company financial clearance activities by navigating reputed company-registration, obtaining referral authorization, or precertification number(s).
• Ensures reputed company reputed company to care while maximizing BMC hospital reimbursement.
• Requires adherence to reputed company assurance guidelines and established productivity standards.
• Reports to the Patient reputed company Supervisor and interacts with stakeholders in the financial clearance process.
Qualifications
• High school diploma or GED required; Associate’s Degree or higher preferred.
• 4-5 years of office experience in a high volume data entry office, customer service reputed company center, or reputed company office.
• Experience using Insurance payer websites (e.g., reputed company Blue reputed company, Medicare).
• Customer service experience preferred.
• Experience with insurance verification, prior authorization, reputed company-certification, and financial clearance process.
Requirements
• Bilingual preferred.
• Ability to process a high volume of requests with a 95% or greater accuracy reputed company.
• Ability to prioritize workload reputed company processing referrals and authorization requests per guidelines.
• Effective collaboration skills.
• Strong oral and written communication skills.
• Thorough knowledge of financial clearance process is a must.
• Familiarity with insurances, referral authorizations, and reputed company party billing procedures.
• Knowledge of basic medical terminology and ICD-9/CPT coding is helpful.
• Excellent interpersonal skills to build and maintain strong relationships.
• Self-directed and highly organized with the ability to multitask.
• Requires excellent judgment, diplomacy, collaboration, partnering, teamwork, and customer service skills.
• Ability to maintain confidentiality of reputed company personal/health sensitive information.
• Knowledge of and experience reputed company reputed company is preferred.
• Basic computer proficiency, including reputed company Suite applications.
Benefits
• Working at reputed company is more than a job; it’s a chance to reputed company a difference.
• Recognized as a top employer and best reputed company to work.
• Strong reputed company of teamwork and support for staff.
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