PAS PSO Prior Authorization Specialist III WMCG

Wellstar Health System; Magnolia (AR); On-site; USD 42,000 - 54,000; Full time

Job summary

Wellstar Health System in the United States is seeking a PAS Prior Authorization Specialist III. This role reports to the PAS Manager of Pre-Service Operations and focuses on securing authorizations and gathering benefit information before services are rendered.

You'll collaborate with physicians, nurses, clinic managers and financial advocates to resolve issues in the authorization process, maintain documentation, and support pre-registration when needed in a fast-paced environment.

Qualifications

• Experience with insurance verification and prior authorization.
• Familiarity with ICD/CPT coding.
• Ability to work in a fast-paced healthcare environment.

Responsibilities

• Verify insurance eligibility and benefits and create pre-service estimates.
• Submit accurate ICD/CPT codes and documentation.
• Secure prior authorizations for scheduled and unscheduled services.
• Serve as liaison between payer and clinic staff.
• Follow up on delayed or denied authorizations.
• Maintain detailed authorization records.
• Perform other duties as assigned.
• Observe attendance and notify about absences punctuality.

Skills

Insurance verification

Prior authorization

Medical terminology

Documentation

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what’s possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people’s lives.

Work Shift

Day (United States of America)

Job Summary:

The Patient Access Services (PAS) Prior Authorization Specialist III position reports to the PAS Manager of Pre-Service Operations and is responsible to secure accounts by performing a combination of insurance verification to gather benefit information if not already obtained and validating prior authorization has been initiated with the payer before services are rendered. This position works with physicians, nurses, clinic managers and financial advocates to resolve issues that arise during the prior authorizations process. This position may also support Pre-Registration including preparing patient estimates. Maintain established productivity benchmarks and meets goals in a fast-paced environment. Other duties as assigned.

Core Responsibilities and Essential Functions:

Quality/Safety

• Works in conjunction with Insurance Verification Specialist to verify insurance eligibility, benefits, network status and creates pre-service liability estimate.
• Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
• Secures prior authorizations for scheduled and nonscheduled services.
• Acts as a liaison between the payer and clinic schedulers/medical support staff.
• Follows up on delayed or denied authorization requests and escalates for resolution.
• Creates detailed documentation and maintains/stores the authorization paper/electronic trail.
• May work in the work queues to resolve claims denials related to the prior authorization.
• Perform other work-related duties as requested/directed by management.
• Observes work hours and provides proper notice of absences, tardiness