Join our team who is committed to the delivery of the highest quality health care service. We are seeking a full-time Prior Authorization Specialist that is self-motivated, energetic, and a take charge individual.
Review scheduled appointments, verify insurance, and determine the need for prior authorization. Reschedule/pend/hold all scheduled appointments if prior authorization is required and not in effect.
Work with providers to determine care plan and services to be provided under prior authorization.
Submit all services that require prior authorization to insurance carrier either on-line or via FAX.
Develop and maintain record of all submitted requests for prior authorizations.
Follow up on authorizations not received in a timely manner.
When authorization is received, enter authorization information into Intergy and EHR.
Notify patient that prior authorization has been received and schedule appointment.
Notify provider that authorization is in place and what service(s) is approved. Provide Advance Beneficiary Notice information to provider and patient if needed.
Monitor service(s) provided to be certain the billed service(s) matches the authorized service(s). Notify Manager if there are discrepancies.
Develop and maintain a method to track prior authorization services and dates to eliminate risk of providing service(s) that exceed the limits of the authorization.
Determine need for additional authorization and submit requests for continuing services if necessary.
High school diploma or GED
Excellent oral and written communication skills.
Working knowledge of computers and office applications software.
Proven working knowledge of the prior authorization process and related carrier requirements.
No Phone Calls Please. Qualified applicants may apply online, send resume to Sue Raymond, Vice President of Human Resources, Sixteenth Street Community Health Centers, 1337 S. 16th St., Milwaukee, WI 53204 or fax to 414-672-0413. Sixteenth Street Community Health Centers is an equal employment opportunity employer.