Prior Authorization Specialist Innovation Care - Scottsdale, United States - HonorHealth

HonorHealth

Verified Company

Scottsdale, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Overview:

Looking to be part of something more meaningful? At HonorHealth, you'll be part of a team, creating a multi-dimensional care experience for our patients.

You'll have opportunities to make a difference.

From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact.

Join us. Let's go beyond expectations and transform healthcare together.

High School Diploma or GED Required

Experience

1 year health plan based prior authorization experience. Required

Responsibilities
:
Job Summary

The Prior Authorization (PA) Specialist is responsible for the review of requests for authorization of services and coordinates the timely completion of the authorization process for Utilization Management Department.

The PA Specialist will review referral and admission requests, verify eligibility, benefit information and determine whether sufficient clinical information has been submitted for review utilizing health plan, CMS, MCG or other nationally recognized criteria/guidelines, approves referrals and admission requests if criteria and guidelines are met.

Receives referral and admission requests from practices and acute/postacute facilities. Verifies patient's demographic and insurance information within billing system. Coordinates PA process in MCG software and ensures appropriate documentation for criteria is met. Approves request or sends request for the Medical Director/designee review if criteria and guidelines are not met. Maintain a productivity PA case load of an average of 1015 prior auth processing per day.
Requests additional information from medical office staff members and referring physicians as necessary
Identifies potential risk /quality management cases using established criteria and refers to Director. Coordinates PA issues with organization's Medical Director/Designee. Follows organizations PA policies and procedures. Maintains professional conduct and good working relationships with coworkers, supervisors and other provider practices.
Maintains accurate logs of PA authorizations within software date stamp all received documents sent to organization for processing. Obtains prior authorizations and referrals from practices in accordance with organization's requirements using website and fax systems. Reviews medical records within IE and/or EPIC for appropriate submission to obtain authorizations.

Facility:

Innovation Care Partners Department:
Medical Management Work Hours: 8:00-4:30 Shift: 0- Days Position Type: Regular Full-Time