Prior Authorizations Specialist - Neuro Muscular

Location

85 Seymour Street - HHMOB (10117)

Monday - Friday

Under the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain insurance prior authorizations for all in‑office procedures, medications, and any surgical services in a timely manner. Responsible for creating, maintaining and managing resources, including insurance portal access. Must have consistent documentation in EPIC to support the obtained insurance authorization. Will communicate changes in payer and/or federal regulatory guidelines to their manager, providers and other clinical departments, as applicable.

• Monitors and reviews the prior authorization work queue daily to verify accuracy of patient’s insurance information and interpret insurance pre‑authorization requirements for scheduled procedures, surgery, or medication.
• Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled date of procedure.
• Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.
• Immediately communicates to provider when a procedure, medication or surgery is denied by the insurance company. Assists in setting up peer‑to‑peer reviews.
• Collaborates and communicates with pharmacy regarding preferred drugs on the particular insurance plan and notifies providers of alternatives.
• Maintains log of missed prior authorizations and assists manager with timely retro authorizations or appeals to recoup revenue.
• Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.
• When time allows can help out in the office with managing incoming phone calls, baskets and other front desk coverage, answering phones and transcribing orders and referrals.
• Monitors referral work queue, registers arriving patients, answers incoming calls as well as other assigned duties as needed.

• High School Graduate/Diploma preferred.
• At least one year experience working with insurances and prior authorizations, preferred.
• Experience and knowledge of insurances and prior authorizations.
• Ability to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companies.
• Must be self‑motivated and have the ability to work independently and within a team.
• Demonstrates excellent telephone, computer, organization and customer service skills.

Competitive benefits program designed to ensure work/life balance.