Pre-Authorization Specialist

MISSION STATEMENT
“To provide accessible, compassionate holistic care that strengthens our community.”
Full-time position (40 hours weekly Mon-Fri))

We Value Our Employees By Offering:

• Medical, Dental, Life, and Health Care Benefits (FT)
• Up to 3 weeks of paid/sick time off plus 10 Holidays per year (FT)

Position Summary:
The Prior Authorization Specialist works with all departments and insurance companies to obtain the necessary authorizations for services or medications that require prior-authorizations. Once authorization is received authorization is communicated to staff and recoded into EHR system to ensure proper billing. The Prior Authorization Specialist must maintain a high level of understanding of insurance companies and billing authorization requirements.

Qualifications:

• Must have a High School Diploma or equivalency
• Must have one year of medical insurance verification or prior-authorizations related experience
• Knowledge of insurance terms and reimbursement procedures
• Excellent verbal and written communication skills required
• Excellent telephone etiquette

Skills & Competencies:

• Interpersonal skills. Must have the ability to co-operate and collaborate as part of a team. Takes actions that indicate consideration for others. Promotes effective working relations as part of a department and interdepartmentally to facilitate the department and organization’s ability to meet its goals and objectives.
• Decision-making skills. Must be able to apply common sense reasoning and decision-making to carry out detailed, involved billing transactions and to resolve problems involving several concrete variables.
• Critical Thinking. Must work assignments on time/readily accepts assignments as observed by supervisor.
• Discretion. Must be able to adhere to strict confidentiality

ESSENTIAL DUTIES/RESPONSIBILITIES:

• Coordinates prior-authorization for procedures, orders, or medications by verifying the correct authorization form, obtaining all necessary information to complete form, and submitting the form to the correct insurance plan.
• Works with patients and insurance companies to secure retroactive insurance coverage and authorizations.
• Tracks and follow-up on all pending authorizations or requests for additional information depending upon payer guidelines to expedite the claim process.
• Notifies appropriate staff of approved medical or medication authorizations and enter approved authorizations into the EHR.
• Works closely with billing, providers and clinical teams.
• Knowledgeable in inpatient and outpatient coding, including and understanding of: behavioral health, medical and psych procedures, ICD-10-CM, CPT, HCPCS, primary care, and residential.
• Be courteous, professional and have a positive demeanor with co-workers and others while performing essential duties.
• Performs other duties as required by Director of H.I.M. & Compliance and Chief Operating Officer.

EOE/Non-smoking facility. Pre-employment drug screening/background check required. ** All candidates must be able to obtain a DPS Fingerprint Clearance card.

It is the policy of Polara Health not to discriminate against any employee or any applicant for employment because of age, race, religion, color, handicap, sex, physical condition, disability, sexual orientation, protected veteran status or national origin. This policy shall include, but not be limited to, the following: recruitment and employment, promotion, demotion, transfer, compensation, selection for training including apprenticeship, layoff and termination. PH further agrees to take affirmative action to ensure equal employment opportunities.