Prior Authorization Specialist - Pulmonology
St Luke's Duluth
Part-time
On-site
Healthcare Insurance and Claims
Summary
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JOB SUMMARY
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The Prior Authorization Specialist, under the direction of the Pulmonology Manager/Supervisor, is responsible for verifying health insurance, obtaining benefits and meeting payer requirements to secure prior authorizations for medications. Verifying insurance coverage, resolving any issues with authorization and escalating complicated issues to appropriate manager/supervisor. The Prior Authorization Specialist acts as a liaison between patients, their health insurance, and care providers to assist in the understanding of their pharmacy benefit and responsibility. Writes appeals to insurance provider and seeks input from physician on appeals as needed. Enrolls patients in drug assistance programs if patient is eligible.
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MINIMUM QUALIFICATIONS
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Education: High School graduate or equivalent.
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Experience: At least one (1) year of experience in healthcare, finance, or related setting.
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Licensure/Certification/Registration: N/A
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PREFERRED QUALIFICATIONS
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Education: Associates Degree in related field.
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Experience: Training and/or experience in follow-up or collection technique, medical terminology, and medical records coding and/or managed care reimbursement. Experience with obtaining insurance benefit investigation and prior authorizations.
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Licensure/Certification/Registration: Registered Technician with Minnesota Board of Pharmacy.
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KNOWLEDGE, SKILLS AND ABILITIES
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Knowledge of Microsoft Outlook, Word and Excel. Strong computer skills and current computer technology experience. Ability to demonstrate strong personal interaction skills. Must demonstrate good written and verbal communication skills as well as analytical capabilities. Communication activities promote positive patient relations and prompt reimbursement. Knowledgeable in office functions and processes.
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READING - Intermediate: Ability to read and interpret documents such as operating and maintenance instructions and procedure manuals.
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WRITING - Intermediate: Ability to write routine reports, correspondence, or procedures.
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SPEAKING - Intermediate: Ability to effectively present information in one-on-one, small group situations or before groups of customers, clients, and other employees of the organization.
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MATHEMATICAL SKILLS - Intermediate Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals and to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to compute rate, ratio, and percent and to draw or interpret bar graphs to apply concepts of basic algebra and geometry.
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REASONING ABILITY - Intermediate Skills: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
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PHYSICAL DEMANDS AND ENVIRONMENT
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PHYSICAL DEMANDS
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Ability to talk, hear, sit, stand, and reach for a period of eight (8) hours
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Stand - Occasionally Under 1/3 (1-2.5 hours)
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Walk - Occasionally Under 1/3 (1-2.5 hours)
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Sit - Continuously Over 2/3 (5.5 – 8 hours)
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Use hands to finger, handle, or feel - Continuously Over 2/3 (5.5 – 8 hours)
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Reach with hands and arms - Occasionally Under 1/3 (1-2.5 hours)
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Stoop, squat, kneel, or crouch - Occasionally Under 1/3 (1-2.5 hours)
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Bending-repetitive forward - Occasionally Under 1/3 (1-2.5 hours)
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Talk or hear - Continuously Over 2/3 (5.5 – 8 hours)
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LIFTING REQUIREMENTS-
Up to 10 pounds - Frequently 1/3 to 2/3 (2.5 – 5.5 hours)
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Up to 25 pounds - Occasionally Under 1/3 (1-2.5 hours)
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WORK ENVIRONMENT-
Typical Noise Level - Moderate noise (examples: business office with computers and printers, light traffic)
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WORKING CONDITIONS
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Typical office environment with computer usage
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