Employment

Prior Authorization Specialist

Posted: September 22, 2021

Description

The Authorization Specialist functions as a primary liaison between patients, providers, and leaders throughout THS and reports to the Imaging Director. Also serves as a liaison between referring clinicians, hospital facilities as well as all other collaborating relationships of THS. This position will also work in collaboration with any and all applicable departments in the effort of obtaining insurance.

Position Responsibilities/Duties:

  • Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
  • Request, track and obtain prior-authorization from insurance carriers within time allotted for outpatient imaging, surgery and lab services
  • Request, follow up and secure prior-authorizations prior to services being performed
  • Works in collaboration with medical sites to obtain any additional clinical documentation that can be forwarded to insurance carrier
  • Provides direct support to primary care practices and specialty care providers regarding utilization, authorization, and referral activities
  • Proficient in the use of ICD-9 and CPT codes. (ICD-10 preferred)
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
  • Communicate any insurance changes or trends among team
  • Maintains a level of productivity suitable for the department
  • Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
  • Other duties as assigned

Schedule: Full Time (40 hours/week)
Contact: Vanessa Garcia
Phone: 575-751-5731
Email: vgarcia@taoshospital.org

Qualifications

  • High School diploma or GED with 2 years of college or professional school preferred
  • 2 years of experience working in the medical field
  • Familiarity with electronic medical record required
  • Knowledge of online resources to obtain prior-authorizations
  • 1 year experience with ICD-9 and current with ICD-10, CPT codes
  • Demonstrates overall knowlegde of managed care plans
  • Comprehensive working knowlegde of 3rd party insurance processes required
  • Intermediate to expert knowledge and computer skills including Windows porgrams and database applications preferred. 
  • Includes good keyboard skills 45+ wpm with high accuracy rate
  • Understanding of insurance payor reimbursement, authorization, practice management systems follow-up helpful
  • Ability to prioritize tasks, work independently, and in a close environment with peers
  • Strong leadership skills with attention to detail and accuracy