Prior Authorization Specialist - Financial Counselor

GENERAL JOB DESCRIPTION: Responsible for all insurance verifications, benefit documentation, referrals, preparing procedure estimates and authorization for assigned location(s)/doctor(s).

ESSENTIAL FUNCTIONS:

• 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.

QUALIFICATIONS

Education: High School diploma

Experience:

• Two year previous experience in a medical office setting
• Previous experience with insurance benefit verification

Licensure: 

Special Skills:

• 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

Physical Demands:

Environmental Working Conditions:

• Continuously handle multiple tasks simultaneously and work as a part of a team.
• No conditions of chemicals/fumes/odors and dust/messiness.