Prior Authorization Specialist
On-siteCalifornia, United States or Birmingham, Alabama, United States
Job Summary
Review and process requests for prior authorizations and pre-determinations, ensuring proper supporting documentation is completed. Coordinate with Intake Specialists and the Pharmacy Team to identify services requiring authorization, then process requests via fax, computer, or phone call as required by specific payers. Verify benefit coverage, identify out-of-pocket costs, and document all interactions in the EMR, including expiration dates and tracking pending authorizations. Troubleshoot denials by communicating with the Revenue Cycle Team and follow up on requests to ensure timely resolution. Maintain an organized process for second checks on newly accepted patients and adhere to HIPAA guidelines regarding protected health information.
Required Qualifications
- 2 or more years of experience in healthcare reimbursement with focus on insurance verification and authorizations
- Experience with coordination of benefits, including but not limited to HMO, PPO, TPA, state and federal payors
- Prior work in specialty or home infusion, homecare or related field
- Strong computer skills (Microsoft Word, Excel, PowerPoint)
- Exceptional communication - verbal and written
- Exceptional interpersonal skills
- Exceptional organizational and process skills
- Ability to work well under pressure, meet timelines, and completes assigned projects
- Exceptional critical thinking and problem solving skills
- Proven performance, history in related field
- Exceptional attention to detail and demonstrated results
- Exceptional track record of customer satisfaction
Desired Qualifications
- Experience with coordination of benefits, including but not limited to HMO, PPO, TPA, state and federal payors; preferred but not required
- Prior work in specialty or home infusion, homecare or related field; preferred but not required
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