Referral and Prior Authorization Specialist

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Referral and Prior Authorization Specialist (2383309)

Referral and Prior Authorization Specialist

2383309

This position is Remote in Oregon. If you are located within commutable distance to the office at 3680 NW Samaritan Drive, Corvallis, you will have the flexibility to work remotely
* as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Prior-Authorization Specialist coordinates and facilitates the process of internal and external authorizations for patients of The Corvallis Clinic.

This position is full-time, Monday
- Friday. Employees are required to work during our normal business hours of 8:00am - 4:30pm PST. It may be necessary, given the business need, to work occasional overtime.

We provide up to 4 weeks of onsite training. Monday – Friday 8:00am - 4:30pm PST. Training will be held at 3680 NW Samaritan Drive, First Floor, Corvallis, OR 97330.

Primary Responsibilities:

• Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlines in the Service and Behavioral Standards Handbook. To this end, employee will be expected to read, have familiarity, and embrace the principles contained within
• Efficiently obtains all authorizations for medical procedures to be performed prior to patients scheduled date of service
• Processes authorizations and submit clinical supporting documentation to insurance carriers
• Documents all prior authorization information including approval dates, prior authorization number in patient chart
• Reads medical documentation and does medical chart review prior to requesting authorization. Reviews the medical records, diagnosis and laboratory reports. Reviews accuracy and completeness of information requested and ensures that all supporting documents are present
• Notifies scheduling and clinical staff of delays in obtaining these authorizations
• Ensures that insurance carrier documentation requirements are met and authorization documentation is scanned and documented in the patient’s medical record. Reviews order to determine if testing will warrant obtaining an authorization or if the testing is a covered benefit not requiring an authorization through the patient’s insurance coverage. Maintains timely communication with ordering physicians and clinical staff when missing information has not been received
• Completes follow-up as needed with physicians, clinical staff, and insurance companies
• Monitors authorization requests to ensure timely processing and completion
• Communicates approvals and denials to the ordering physician and assists with any denials or issues to resolve
• Reviews denials and submits appeals if requested by physician in an effort to obtain approval by insurance companies
• Researches, corrects, and re-submits rejected and denied claims. Prepares reconsiderations and works with the billing staff if the denial need to go to an appeals level
• Informs supervisor about any changes or patterns when working denials of procedures
• Collaborates with other departments to assist in obtaining pre-authorizations in a cross-functional manner
• Ability to handle high workload…