- Understanding of insurance requirements for prior authorization
- Understanding of payer processes (website, fax, contact number) to submit appropriate authorization request
- Understanding of insurance billing procedures and practices
- Finding and understanding clinical information from EMR regarding services to be rendered
- Contacting payers to obtain prior authorization
- Following policy and procedures on treatment therapies and substitutions
- Advising providers and their clinical staff when issues arise relating to obtaining prior authorization
- Navigating and using national medical guideline tools
- Verifying that all insurance requirements have been met before noting approvals
- Following the workflow process on all pending cases
- Serving as primary contact with outside facility request with our clients
- Responding to all client emails and calls within the agreed upon policy timeframe
- Noting and applying all authorization correspondence in both PM and EMR systems
- Maintains the practices and principles set forth by AC3 leadership with a strong commitment to service, excellence, and quality.
- Maintains professional behavior, confidentiality, and discretion always, along with the ability to work with all levels of staff with a confident and professional demeanor.
- Follows HIPPA rules and regulations.
- Minimal of a year of previous experience in a Prior Authorization role
- High school diploma or equivalent (GED).
- Medical office experience/medical terminology preferred.
- Accurately maintains and adheres to all safety rules and regulations.
- Must be detail oriented and have problem solving abilities.
- Proficient in Microsoft Office preferred.
- Working knowledge/experience in electronic medical records and/ or other medical software if applicable.
- Must possess the ability to work with patients and family members in a confident, respectful, and socially professional manner.
- Must rely on experience and judgment to plan and accomplish goals.
- Excellent communication and organizational skills with the ability to work in a fast-paced environment; prioritize tasks and workloads.
- Performs other duties as assigned.
- This is a remote position with the expectation of travel to meet the needs of the position. Work is completed in a general office environment, sedentary in nature but may require standing and walking for up to 10% of the time. The work environment is favorable with adequate lighting and temperature, and no hazardous or unpleasant conditions caused by noise, dust, etc. Must be able to operate standard office equipment and keyboards.
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Medical Prior Authorization Specialist - South Bend, United States - Human Resource Department
Description
WHO WE ARE:AC3 was founded by practicing oncologists along with data and practice analytics experts to support the business side of medicine. Our mission is to modernize and digitize the delivery of healthcare and improve countless lives along the way.
We combine the power of big data technology and people to enable easier frontline decisions about complex problems. AC3 offers its employees an exciting, fast-paced, and challenging work environment. To learn more about AC3, visit us at
COMPANY MISSION: To simplify healthcare and reduce the cost of care, empowering care givers to focus on what matters most – fighting cancer.
POSITION SUMMARY: This is a hybrid position; meaning there may be onsite requirements. Ideal candidate should reside within a 2 - 3 hour commute radius from South Bend. The prior authorization (also called "preauthorization" and "precertification") position obtains approval of a health care service or medication before the care is provided. He/ She works with the client, insurance, and patientto evaluate whether care is medically necessary and otherwise covered.This position obtains prior authorization for radiology exams, radiation therapy, procedures, and chemotherapy drugs. They will be responsible for documenting and entering required information in our systems.
Essential Function and Job Responsibilities
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Come join our Winning Team
