[Hiring] Prior Authorization Specialist I @BMC Software

Role Description

Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including a broad range of requests for inpatient, outpatient, and ancillary services. Adheres to policies and procedures in order to comply with performance and compliance standards and to ensure cost-effective and appropriate healthcare delivery.

• Maintains current knowledge of network resources for referral and linkage to member’s and provider’s needs.
• Authorizes certain specified services, under the supervision of the manager, according to departmental guidelines.
• Forwards specified requests to the clinician for review and processing.
• Answers ACD line calls from providers and other departments and redirects as needed.

The Prior Authorization Specialist role belongs to the Revenue Cycle Patient Access team and is responsible for coordinating all financial clearance activities by navigating all pre-registration, obtaining referral authorization, or precertification number(s). This role ensures timely access to care while maximizing BMC hospital reimbursement.

• Requires adherence to quality assurance guidelines and established productivity standards.
• Reports to the Patient Access Supervisor.
• Requires interaction and collaboration with important stakeholders in the financial clearance process.

This is a Remote Position.

Qualifications

• High school diploma or GED required.
• Associate’s Degree or higher preferred.

Requirements

• 4-5 years of office experience, specifically in either a high volume data entry office, customer service call center, or health care office or hospital administration is required.
• Experience using Insurance payer websites (i.e., Blue Cross Blue Shield, Medicare, etc.).
• Customer service experience preferred.
• Experience with insurance verification, prior authorization, pre-certification, and financial clearance process.

Benefits

• Compensation Range: $25.80 - $31.43.
• Generous total compensation that includes benefits (medical, dental, vision, pharmacy).
• Contract increases, Flexible Spending Accounts, 403(b) savings matches.
• Earned time cash out, paid time off, career advancement opportunities.
• Resources to support employee and family wellbeing.

Company Description

Equal Opportunity Employer/Disabled/Veterans.

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