Prior Authorization Specialist-Neurosurgery- Allouez - Green Bay, United States - Prevea Health

Description

Job Description and Essential Functions

Job Title/Position:
Prior Authorization Specialist


Job Classification:
Administrative/Professional Support


Date of Analysis:
Date of Revision/Review:

__________________________________________________________________________________________

Brief Description of Job Responsibilities:

Providing exceptional care for our patients as well as recognizing the value of your co-workers is the expectation of all members of the Prevea Health organization.

All members are expected to focus on the patient's needs; relate to all in a friendly, accepting manner; communicate in a positive and professional way to patients and co workers; use time effectively and efficiently; and demonstrate an overall high level of performance.

Specialized Responsibilities:
(This list may not include all of the duties assigned)

• Works closely with department physicians and staff, coding and billing staff, to ensure understanding of information needed to obtain proper authorization for payment.
• Communicates with patients prior to specialty consultation or surgical procedure to provide them with information regarding their coverage.
• Identifies what is required for Preauthorization of surgical procedures and completes the process to minimize denial of claims.
• Preauthorization documentation.
• Communicate with hospitals and patient on progress/approval of Preauthorization

Performance Requirements:

• General computer knowledge needed to navigate electronic medical record and for documentation.
• Excellent organizational skills.
• Excellent communication skills and follow through with internal and external customers

Education/Experience/Certifications:

• High school diploma or GED.
• One year of experience in a medical or insurance role preferred.
• Knowledge of insurance and medical terminology.
• Knowledge of CPT/ICD-9 coding useful

Non-Essential Duties:
Work is performed in an office environment. Involves frequent contact with staff and the public. Work may be stressful at times.


Typical Physical Demands:

• Typical Working Conditions:
• Other duties as assigned.

Work may require hand dexterity for office machine operation, stooping and bending to files and supplies, mobility to complete errands or deliveries, or sitting for extended periods of time.

Manual dexterity for using a calculator and computer keyboard.

Essential Functions/Physical Demands


Job Title/Position:

PSR

Job Classification:
Administrative/Professional Support

Frequency of activity required to perform the job

Never

(0% of work day)

Seldom

(1-10% of work day)

Occasional

(11-33% of work day)

Frequent

(34-66% of work day)

As Required

( Greater than 67% of work day)

Physical Requirements

Sit

x

Stand

x

Walk

x

Drive

x

Climb (Stairs/Ladders)

x

Bend (Neck)

x

Bend (Waist)

x

Squat

x

Kneel/Crawl

x

Twist/Turn (Neck)

x

Twist/Turn (Waist)

x

Lift/Carry 0-10 lbs.

x

Lift/Carry 11-25 lbs.

x

Lift/Carry 26-35 lbs.

x

Lift/Carry 36-50 lbs.

x

Lift/Carry 51-75 lbs.

x

Lift/Carry lbs.

x

Lift/Carry > 100 lbs.

x

Push/Pull up to 10 lbs.

x

Push/Pull 11-25 lbs.

x

Push/Pull 26-35 lbs.

x

Push/Pull 36-50 lbs.

x

Push/Pull 51-75 lbs.

x

Push/Pull lbs.

x

Push/Pull > 100 lbs.

x

Reach (Above shoulder level)

x

Reach (Below shoulder level)

x

Simple Grasping (Hands/Arms)

x

Fine Manipulation (Hands/Arms)

x

Gross Manipulation (Hands/Arms)

x

Vision Requirements

Color Discrimination

x

Near Vision (Correctable to Jaeger 2 or 20/30 binocular)

x

Distance Vision (Correctable to Snellen chart 20/30 binocular)

x

Hearing Requirements

Hears Whispers < 3 feet

x

Hears Whispers 3-8 feet

x

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled