Prior Authorization Specialist - Cass County Memorial Hospital

• Position Summary
  • The Prior Authorization Specialist is responsible for all aspects of the prior authorization process, as required by worker’s compensation carriers and individual insurance companies, and dependent upon the plan coverage for all patients, in order to proceed with medical testing, treatments and procedures. Assists with immediate authorization needs for testing, treatments and procedures that are changed at time of service. Contacts patients for updated insurance information, when applicable, and coordinates with the Financial Counselor, as appropriate. Assists with problem resolution related to the authorization issues.
• Education and Experience Requirements
  • EDUCATION:
    • Required:
      • High School diploma or GED
    • Preferred:
      • Completion of an accredited Medical Assistant program, nursing program, or medical coding program.
  • LICENSES AND CERTIFICATIONS:
    • Required:
    • Preferred:
      • Current, unrestricted Medical Assistant Certificate, LPN license, or Certified Professional Coder (CPC).
  • TRAINING AND EXPERIENCE:
    • Required:
      • Understanding of medical terminology and clinical documentation
      • Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers
      • Ability to manage multiple competing priorities and to effectively anticipate and respond to issues as needed in a dynamic work environment
      • Ability to use PC based office productivity tools (e.g. Microsoft Outlook, Word, Excel) as necessary; general computer skills necessary to work effectively in an office environment
    • Preferred:
      • Experience with prior authorizations for medical testing, treatments and procedures
      • Knowledge of coding (CPT, HCPCS, ICD-10)
      • Experience with Epic electronic health record
• Essential Job Functions
  • Utilizes various means of communication, such as telephone, fax and web-based programs to collaborate with insurance companies, worker’s compensation carriers, medical providers’ offices, pharmacies and other pertinent entities in obtaining prior authorization approvals for medical testing, treatments and procedures
  • Documents interactions with insurance companies related to prior authorization approvals for medical testing, treatments and procedures
  • Identifies and communicates with providers when authorization requirements change
  • Maintains knowledge of prior authorization requirements from all insurance companies
  • Assists in researching prior authorization requirements for new services to be provided within the health system
  • Performs all other duties as assigned.

PI253907038