Patient Support - Prior Authorization Specialist

Tribe513; South Carolina; Presencial; USD 42.000 - 62.000; Jornada completa

Descripción de la vacante

Tribe 513 is seeking a Prior Authorization Specialist to manage prior authorizations for surgeries, obstetrical care, medications, and imaging at Pelham Place. This in-person, full-time role reports to the Manager, Business Operations in a physician office setting.

You will initiate authorizations, handle Medicaid notifications, and communicate PA status to patients while collaborating with referrals, scheduling, administrative, and clinical teams to ensure accuracy and efficiency.

Formación

• Minimum education: High School Diploma or GED.
• Minimum of 1 year of experience in the medical field, experience facilitating prior authorizations preferred.
• Excellent interpersonal and communication (oral and written) skills with customer service focus required.
• Expert computer skills and typing.

Responsabilidades

• Initiating, creating, and facilitating the prior authorization process for surgeries, obstetrical care, medications, and diagnostic imaging.
• Initiating Medicaid pregnancy notifications and Medicaid sterilization consents.
• Responding to telephone encounters or patient message requests for prior authorization and communicating with the ordering provider as necessary.
• Communicating updates regarding PAs with patients and returning calls with questions about prior authorization.
• Other duties as assigned.
• Promotes an authentic, transparent work environment and ensures the Tribe Way is experienced by patients, families, and team members.

Educación

High School Diploma or GED

Descripción del empleo

Job Title: Prior Authorization Specialist
Weekly Hours: Full-Time, 40 hours/week
Supervised by: Manager, Business Operations
Location: Pelham Place, In Person

Overview

Responsible for managing prior authorizations for Parkside OB-GYN, including, surgeries, medications, diagnostic imaging, and obstetric care. Initiating prior authorizations when orders are placed or upon request from specialty offices, pharmacies, or patients. Communicating with patients by phone regarding the status of their authorizations and collaborating closely with the referrals, surgery scheduling, administrative, and clinical teams to ensure all authorizations are completed accurately and efficiently.

Responsibilities

1. Initiating, creating, and facilitating the prior authorization process for surgeries, c-sections, obstetrical care, medications, and diagnostic imaging.

2. Initiating, creating, and facilitating Medicaid pregnancy notifications and Medicaid sterilization consents.

3. Responding to any telephone encounter or patient message requests for prior authorization and communicating with the ordering provider as necessary.

4. Communicating updates regarding PAs with patients as necessary and returning phone calls from patients with questions about their prior authorization.

5. Other duties as assigned.

6. Takes ownership of ensuring the “Tribe Way” is experienced by patients, families, and team members. Promotes an authentic, transparent work environment within all areas.

Required Education & Certifications

• Minimum education requirement: High School Diploma or GED.

• Minimum of 1 year of experience working in the medical field. Experience facilitating prior authorizations preferred.

• Excellent interpersonal and communication (oral and written) skills with customer service focus required.

• Expert computer skills and typing.

Work environment and Physical Demands

Requires sitting, standing, and walking associated with a normal physician office environment. Person may be exposed to fumes, airborne particles, infectious diseases, blood/bodily fluids, and disease-bearing specimens.

Tribe 513 is an Equal Opportunity Employer