Prior Authorization Specialist - Rural Health Group : Job Details

Rural Health Group is seeking a full-time Prior Authorization Specialist at our RHG @ Halifax Medical Specialist office.A prior authorization specialist is an individual who is highly skilled in ensuring that patients receive the medication and/or diagnostic services that requires pre-authorization from insurance carriers. These individuals address and rectify rejected claims and conduct necessary third party authorization requests.Successful candidate must demonstrate the Rural Health Group Core Competencies, which include:* Good Judgment* Communication/Customer Service/Teamwork* Passion* Honesty* Responsibility* Job-Specific Skill SetESSENTIAL JOB DUTIES AND RESPONSIBILITIES* Follow prior authorization work flow policies and procedures* Collaborate with other departments to assist in obtaining prior authorizations.* Review accuracy and completeness of information requested and ensure that all supporting documents are present* Receive requests for prior authorizations and ensure that they are properly and closely monitored.* Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes* Manage correspondence with insurance companies, clinicians and patients as required* Document all prior authorization information including approval dates, prior authorization number in hospital system* Proactively work on prior authorizations that are timely* Secure patients' demographics and medical information by ensuring that all procedures are in sync with HIPAA compliance and regulation* Advise providers and their clinical staff when issues arise relating to obtaining prior authorization* Stay informed and research information regarding insurance criteria changes/updates for prior authorizationREQUIREMENTS* High school diploma or GED.* 2+ years of related experience; prior- authorization experience highly desired* Knowledge of medical terminology - Understanding of insurance requirements for prior authorization* Experience in Radiology / Pharmacy / Laboratory Prior Authorizations* Understanding of CPT codes and vast knowledge of insurance required* Knowledge of eCW or other electronic health record preferred* Knowledge of Commercial Payors, Medicare & Medicaid desired* Excellent verbal, written, organizational and customer service skills* Ability to work independently, meet deadlines and be flexible* Ability to perform tasks accurately and efficiently when entering data electronically* Proficient typing/keyboarding skills* Basic knowledge of Microsoft Office, Excel and Outlook* Physical Demands: Must be able to sit for long periods of time. Must be able to lift 25-50 pounds. Must be able to ambulate for extended periods of time.* Embraces the team concept; encourages and models healthy, productive team behavior* Bilingual (English/Spanish) is a plus, but not required - applicants who may serve in a translating capacity will be required to take a language assessmentEOE. Federal and State Criminal Background Checks and Drug Screen required for all positions. The Influenza vaccine is a condition of employment.E-Verify Notice: After accepting employment, new hires are required to complete an I-9 form and present documentation of their identity and eligibility to work in the United States.