Prior Authorization Specialist – Financial Counselor

Job Description: • Responsible for all insurance verifications, benefit documentation, referrals, preparing procedure estimates and authorization for assigned location(s)/doctor(s) • Correct and update Registration Information to ensure accuracy in claims filing as identified in the patient account • Prepare estimates for all procedures, notify patients and collect prior to procedures for assigned doctor(s) • Consults with the appropriate provider to obtain clearance that treatment regimen is considered medically necessary before initiating request to the insurance plan • Verifies eligibility and notifies appropriate parties if eligibility has termed • Processes referrals as needed, based upon insurance plan • Submits medical records, works with the provider on necessary documentation, if necessary, to obtain authorization • Notifies clinical staff, related physician and supervisor of any delays in obtaining authorization • Schedules Peer-to-Peer calls when necessary • Communicates any issues with authorization to team lead and appropriate surgery coordinator • Handle patient calls for assigned doctor(s) as necessary, responding within 24 hours • Issue appropriate paperwork for accounts requiring adjustments, patient refunds and corrections when identified • Obtain necessary referrals, document in Referral Management and attach referral in schedule/visit • Receives questions from Office Manager for time of service collection issues the manager cannot resolve with the patient • Work with RCM and Reception Manager to identify ways to increase efficiency in demographic entry • Other duties as assigned Requirements: • High School diploma • Two year previous experience in a medical office setting • Previous experience with insurance benefit verification • Knowledge of medical and insurance terminology • Attention to detail • Ability to effectively communicate both orally and written • Ability to work in a fast paced environment Benefits: Apply tot his job Apply To this Job