Prior Authorization Specialist

• Job Location:
  
  1202 E Locust St - Emmett,
• Position Type:
  Full Time
• Job Shift: Day
• Position Title:
  
  Prior Authorization Specialist
• Department:
  Business Office
• Supervisor’s
  
  Title:
  
  HIM/Business Office Manager

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures performed at Valor Health. Developing and implementing prior authorization workflow, policies, and procedures.

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.
• Request, follow up and secure prior authorizations prior to services being performed at Valor Health.
• Prioritize incoming authorization requests according to urgency.
• Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.
• When necessary, work with billing specialist to obtain a retro authorization.
• Assist with medical necessity documentation and submit medical records to expedite approvals and ensure that appropriate follow up is performed.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Responsible for reviewing all encounters and mailing out Consolidated Summary of
• Attends and participates in meetings as requested.
• Performs other duties as assigned.

• Minimum Education:
  
  High school diploma or equivalent.
• Minimum of 3 years’ experience working in healthcare.
• Minimum of 2 years’ experience as a Medical Assistant/CAN/LPN
• Preferred experience with obtaining prior authorizations.
• Ability to communicate effectively with a wide variety of contacts at all levels of the organization.
• Must have strong organizational skills and attention to detail.
• Strong work ethic and ability to apply critical thinking to a variety of practical and time sensitive situations.
• Working knowledge of Microsoft Office including Word, Excel, and Outlook are required.
• Consistent professionalism in both presentation and demeanor.
• Ability to work with minimal supervision and as a member of a team.
• Ability to Flex Schedule to adjust to workflow.

• Primarily office work. Positions is flexible to be in suite, remote or hybrid.
• General Health care environment exposure to patient conditions.
• Physical Requirements:
  
  Standing, walking, bending, stooping, sitting, hand eye coordination, speaking.