[Hiring] Prior Authorization Specialist @BMC Company 100 ID-14257
Role Description
Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including a broad range of requests for inpatient, outpatient and ancillary services.
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Degree Virtual Assistant, Remote, $42/hr, Weekend, No Experience Phone Support, $35/hr, Weekend, Remote, No Experience- Adheres to policies and procedures to comply with performance and compliance standards.
- Maintains current knowledge of network resources for referral and linkage to member’s and provider’s needs.
- Authorizes certain specified services under the supervision of the manager according to departmental guidelines.
- Forwards specified requests to the clinician for review and processing.
- Answers ACD line calls from providers and other departments and redirects as needed.
- Coordinates all financial clearance activities by navigating all pre-registration, obtaining referral authorization, or precertification number(s).
- Ensures timely access to care while maximizing BMC hospital reimbursement.
- Reports to the Patient Access Supervisor and interacts with stakeholders in the financial clearance process.
Qualifications
- High school diploma or GED required; Associate’s Degree or higher preferred.
- 4-5 years of office experience in a high volume data entry office, customer service call center, or healthcare office.
- Experience using insurance payer websites (e.g., Blue Cross Blue Shield, Medicare).
- Customer service experience preferred.
- Experience with insurance verification, prior authorization, pre-certification, and financial clearance process.
Requirements
- Bilingual preferred.
- Ability to process a high volume of requests with a 95% or greater accuracy rate.
- Ability to prioritize workload when processing referrals and authorization requests per guidelines.
- Effective collaboration skills.
- Strong oral and written communication skills.
- Thorough knowledge of financial clearance process is a must.
- Familiarity with insurances, referral authorizations, and third-party billing procedures.
- Knowledge of basic medical terminology and ICD-9/CPT coding is helpful.
- Excellent interpersonal skills to build and maintain strong relationships.
- Self-directed and highly organized with the ability to multitask.
- Requires ability to make independent decisions under pressure.
- Must maintain confidentiality of all personal/health sensitive information.
- Knowledge of and experience within Epic is preferred.
- Basic computer proficiency, including Microsoft Suite applications.
Benefits
- Opportunity to make a difference as part of our mission to provide exceptional and equitable care.
- Recognized as a top employer and best place to work.
- Strong sense of teamwork and support for staff.
