Prior Authorization Specialist

As an Prior Authorization Specialist, you will be responsible for:

• Determining insurance eligibility, authorization and benefit verification
• Contacting health care insurers, transcription of information as quoted, type, proofread and mail clarification correspondence
• Answer telephone and written inquires
• Maintain filing systems
• Interface with medical staff and administrative personnel

We're seeking a self-directed professional with:

• Working knowledge in the insurance verification process and third party verification terminology
• Ability to scrutinize insurance data independently and evaluate information for clarity, accuracy, and completeness
• Knowledge in the functional operations of third party payers and utilization review agencies to expeditiously coordinate follow-up
• Knowledge of State and Federal programs to ensure reimbursement from Medicare, Medi-Cal, CCS programs, out of state Medicaid, or other sponsoring agencies
• Knowledge of health plans with special processing requirements for emergency patients and ability to effectively communicate these requirements to physicians and administrative personnel under time-urgent conditions
• Proficient in basic math
• Proficient in Microsoft Office Suite, specifically Excel, Word, and Outlook
• Availability to work rotating weekends and holiday coverage

Note: May subject to test qualifying skills