[Hiring] Healthcare Prior Authorizations Specialist @Quadris Team LLC

Role Description

This role involves obtaining prior authorizations for facility services based on assigned specialty or clinic area. The position will secure the prior authorization and notify the rendering party in the timeliest manner possible so patients can receive necessary care and services with the least delay.

• Answer patient calls and provide outgoing patient communication regarding financial obligations and authorization status.
• Responsible for patient estimation, benefit education, and payment processing.
• Accurately, efficiently and timely work prior authorization requests-referrals.
• Receive requests for prior authorizations through the electronic health record (EHR) and/or via phone, email or fax and ensure that they are properly tracked and monitored.
• Transcribe incoming referrals into electronic record (EHR) ensuring accurate patient data entry.
• Monitor incoming referral WQ's to verify insurance eligibility and referral requirements, facilitating timely patient scheduling.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Manage correspondence with insurance companies, physicians, specialists and patients as needed, including documenting in the EHR as appropriate.
• Assist with medical necessity documentation 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.
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
• Prioritize the incoming authorizations by level of urgency and date of service.
• Secure patient information in accordance with client policy/procedures.
• Monitor WQs, and resolve accounts in a timely manner.
• Stay up to date on insurance company policies and procedures related to prior authorizations.

Qualifications

• High School diploma or equivalent.
• 1+ years of experience working in health care, medical billing, with a focus on prior authorization preferred.
• PACS (Prior Authorization Certified Specialist) Certification preferred.
• Knowledge of insurance process and medical terminology preferred.
• Honors and sets high expectations for patient confidentiality and customer service in accordance with Quadris Team policies and procedures and HIPAA requirements.
• Advanced level of industry standard electronic medical record content.
• Must have professional level skills in MS products such as Excel, Word, Power Point.
• Proficient application of business/office standard processes and technical applications.

Requirements

• Maintains compliance with regulations and laws applicable to job.
• Professional level of communication with video, phone, and email.
• Ability to effectively prioritize the work to meet deadlines and expectations.
• Meets the quality and productivity measures as outlined by Quadris.
• Brings positive energy to work.
• Uses critical thinking skills.
• Being present and focused on assigned tasks and eliminates distractions.
• Being a self-starter.
• Ability to work independently and within a team atmosphere.

Company Description