The Prior Authorization Specialist is responsible for tracking the client’s prior authorization status through completion. The Prior Authorization Specialist will accurately process the requests according to regulatory and client-specific guidelines.
- Submit prior authorization forms to the payer
- Contact payers to verify authorization status
- Track and manage the authorization process
- Maintain and update payer prior authorization forms
- Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner.
- Process authorizations based on department guidelines and in accordance with standards and performance indicators
- Maintain all patient confidentiality
- Manage prior authorization activity queue
- Provides timely communication throughout the prior authorization process
- Conducts appropriate follow-up, on a daily basis, on all pending authorizations until a final determination has been made
- Conduct complete medical and pharmacy Benefit Investigations as needed
PHYSICAL AND TECHNICAL ENVIRONMENT:
- Ability to work at a desk in the office for long periods of time.
- The noise level in the work environment is moderate.
- Specific vision abilities required by this job include close vision and color vision.
- Ability to maintain focus under high levels of pressure/multiple priorities.
- Three to five years’ experience in a health plan, facility, healthcare provider office, or pharmaceutical industry
- Experience working with insurance companies and extensive knowledge of different types of coverage and policies.
- Experience with pre-certification or pre-authorization
- Excellent multitasking skills.
- Have exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
- Ability to focus and work quickly within a 24-hour turnaround for patient insurance information.
- Authorization to work in the US without sponsorship.
- Ability to express ideas clearly in both written and oral communications
PREFERRED EXPERIENCE, SKILLS, AND ABILITIES:
- Three to five years’ experience in a call center preferred
- Knowledge of medical terminology preferred
- Working knowledge of drug reimbursement issues
- Understanding of health plan medical policies and prior authorization criteria
- Knowledge of HCPCS, CPT and ICD-10 coding
- Strong computer skills; preferably Microsoft Word or Excel software applications
- Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
- Ability to manage multiple priorities concurrently
- Bachelor’s degree or equivalent work experience
EEO CODE – eBluSolutions is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law. eBlu Solutions is an Equal Employment Opportunity and Affirmative Action Employer.