Prior Authorization & Care Coordination Specialist

Beacon Health System; South Bend (IN); On-site; USD 42,000 - 60,000; Full time

Job summary

Beacon Health System in Indiana is seeking a Prior Authorization Specialist who evaluates designated referred services for authorization needs and disseminates supporting documentation to ensure proper reimbursement. You will deliver empathetic, clear communication to patients, families, and associates about the next steps in care.

The role requires acting as the primary contact for PA, coordinating clinical documentation, verifying insurance requirements, and using multiple EMR and insurance

Qualifications

• Associate's Degree in Business or Health Care field and one year medical authorization or related experience; or, high school diploma or equivalent and three years medical authorization or related experience.
• Medical Assistant Program with Certification preferred.
• Medical terminology, ICD-10, CPT, prior authorizations, third party payors and prior authorization processes required.
• Proficiency with Microsoft Office: Outlook, Excel and Word.

Responsibilities

• Serve as primary contact for designated prior authorization needs.
• Identify, collect, and coordinate clinical documentation to support qualification of ordered services.
• Evaluate orders for insurance coverage and authorization requirements.
• Ensure carrier process requirements are met within contracted guidelines and timeliness.
• Ensure proper testing is done; utilize tools and guidelines for testing and authorization processes.
• Review and comply with additional requests and validate completed authorizations.
• Support the appeal process by coordinating resolution expectations with providers and authorization agents.
• Maintain standardized records for effective coordination, tracking and reporting of department actions.

Skills

Communication skills

Analytical skills

Customer service

Attention to detail

Education

Associate's Degree in Business or Health Care

Medical Assistant Program

High school diploma or equivalent

Tools

EMR systems

Referral databases

Insurance portals

Microsoft Office

Job description

Beacon Health System in Indiana is seeking a Prior Authorization Specialist who evaluates designated referred services for authorization needs and disseminates supporting documentation to ensure proper reimbursement. You will deliver empathetic, clear communication to patients, families, and associates about the next steps in care.

The role requires acting as the primary contact for PA, coordinating clinical documentation, verifying insurance requirements, and using multiple EMR and insurance