Care Access & Prior Authorization Specialist

sluhn; Allentown (Lehigh County); Presencial; USD 28.000 - 36.000; Jornada completa

Descripción de la vacante

St. Luke's is seeking a detail‑oriented pre-registration and authorization specialist to ensure accurate financial clearance for scheduled patients.

You will verify patient information, submit prior authorizations, and coordinate insurance referrals for Primary Care and SL Care Now departments. Responsibilities include reviewing medical necessity, monitoring appointments, and using Epic Work Queues to maintain compliant documentation and timely reimbursements.

Formación

• High school graduate or equivalent.
• Three years healthcare experience in a department or office with a hospital, physician's office, or similar medical facility preferred.
• It is required to have at least one year in areas stated above.
• Strong customer service skills with knowledge of health insurances required.
• Must have the ability to work independently.
• Computer experience required.
• Bilingual preferred.

Responsabilidades

• Responsible for the financial clearance of all scheduled patients by providing accurate and timely verification of all financial information and pre-certification/referral for all services to ensure proper reimbursement.
• Responsible for reviewing medical necessity of genetic testing/infusion services in addition to prior authorization to ensure revenue for services.
• Monitors all hospital scheduled diagnostic and surgical appointments to ensure that all cases are identified, and financial clearance is obtained.
• Submit prior authorizations for all STAT imaging orders for PCP and Specialty prior to date of service.
• Submit for insurance referrals for all PG Specialty and PCP orders and SL Care Now Departments.
• Submit prior authorizations for diagnostic orders placed by PG PCP and Specialty service lines.
• Utilizes Epic Work Queues designed for Prior Authorization and Insurance Referral workflows to ensure correct process is followed for proper documentation and billing in Epic.
• Notifies all external providers of prior authorization requirements for scheduled services.
• Notifies practices of all denied authorizations via in-basket message and provide peer to peer info for scheduling.
• Review payer medical policies and contact the health plan's UR department for first attempt appeal mitigation.

Conocimientos

Customer service

Billing/insurance knowledge

Independent work

Proficient computer skills

Bilingual preferred

Educación

High school graduate or equivalent

Herramientas

Epic

Descripción del empleo

St. Luke's is seeking a detail‑oriented pre-registration and authorization specialist to ensure accurate financial clearance for scheduled patients.

You will verify patient information, submit prior authorizations, and coordinate insurance referrals for Primary Care and SL Care Now departments. Responsibilities include reviewing medical necessity, monitoring appointments, and using Epic Work Queues to maintain compliant documentation and timely reimbursements.