Medical Prior Authorization Specialist - Hybrid

AC3, Inc; South Bend (IN); Hybrid; USD 28,000 - 32,000; Full time

Job summary

AC3, Inc. is seeking aMedical Prior Authorization Specialist for a hybrid schedule in South Bend, IN. The role centers on obtaining prior authorizations for radiology, radiation oncology, and chemotherapy services, with strong emphasis on payer requirements and medical necessity checks.

The candidate should have RadOnc exposure or related medical office experience, superior communication skills, and proficiency with EMR and Microsoft Office. Onsite training plus hybrid remote work is offered.

Qualifications

• High school diploma or GED.
• Prior radiation oncology experience.
• Medical office experience or medical terminology preferred.
• Detail oriented with strong problem-solving abilities.
• Proficient in Microsoft Office.

Responsibilities

• Obtain authorizations for radiology, radiation oncology, chemotherapy, and related services.
• Contact payers to obtain prior authorization.
• Review clinical information in EMR to determine coverage and medical necessity.
• Enter authorization details into PM/EMR systems.
• Communicate with providers and patients to resolve authorization issues.

Skills

Communication skills

Attention to detail

Problem solving

Microsoft Office

EMR software

Education

High school diploma or GED

Tools

EMR systems

Microsoft Office

Job description

Medical Prior Authorization Specialist - Hybrid

Full Time Clerical South Bend, IN, US

Salary Range: $20.00 To $23.00 Hourly

WHO WE ARE:

AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way.That’swhat motivatesus.

COMPANY MISSION:

To help specialty practices thrive.

POSITION SUMMARY:

The Prior Authorization Specialist (also called “preauthorization” and “precertification”) obtains approval for health care services or medications before care is provided. This position works closely with clients, insurance payers, providers, clinical staff, and patients to evaluate whether services are medically necessary and covered under the patient’s health plan.

The Prior Authorization Specialist is responsible for obtaining authorizations for radiology exams, radiation oncology services, radiation therapy, procedures, and chemotherapy drugs. Previous radiation oncology (RadOnc) experience is strongly preferred, with knowledge of radiation oncology treatment workflows, terminology, and payer authorization requirements. The position is also responsible for accurately documenting and entering required information into applicable systems.

Essential Function and Job Responsibilities

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Understanding of insurance requirements for prior authorization, including requirements specific to radiation oncology services and treatments.
• 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.

POSITION REQUIREMENTS

• High school diploma or equivalent (GED).
• Prior radiation oncology (RadOnc) experience.
• 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.

WORK LOCATION:

This is a full-time hybrid/remote position; meaning, there will be required onsite training and the combination of a remote and onsite work schedule. The ideal candidate will reside within a 30-mile radius of the office located in South Bend, IN.

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.

WHY WORK AT AC3?

When you become an AC3 Team member, you can expect ongoing training, support, and a work culture like no other. We offer our Full-Time Team Members medical, dental and vision health and wellness benefits, along with employer paid life insurance, long and short-term disability policies. Because our team’s health and wellness are our priority, we start new hires off with an above average paid time out plan and offer a comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support. We also provide all Team Members with access to company sponsored financial wellness counselors, employee assistance services and the opportunity to enroll in our company-matched, 401k plan.