Prior Authorization Specialist

Bayou-Bend-Health-System; Louisiana (MO); On-site; USD 48,000 - 62,000; Full time

Job summary

Bayou Bend Health System in Franklin, LA seeks a Prior Authorization Specialist to support physicians and the care team by obtaining approvals, verifying benefits, and documenting authorizations to ensure timely patient care.

The role requires an LPN license in Louisiana, BLS certification, MOAB preferred, and involves clerical tasks, coordination with clinics, and submitting appeals when needed.

Qualifications

• Requires an LPN license in Louisiana.
• BLS Certification required upon hire.
• MOAB Certification preferred.

Responsibilities

• Efficiently obtain authorizations for procedures to be performed prior to patients being scheduled.
• Verify insurance for in-network or out-of-network eligibility and benefits.
• Pre-certify services including surgery, office visits, diagnostic testing, and any procedure requiring authorization.
• Maintain referral and authorization record documentation.
• Consult with physicians, nurses, staff and providers regarding the referral and pre-certification process.
• Monitor outstanding authorization requests and follow up as needed.
• Prepare and submit appeals on behalf of patients; handle incoming inquiries.
• Assist in routine clerical tasks such as faxing, scanning, and updating patient records.
• Communicate with patients to obtain required information for processing prescriptions and authorizations.
• Obtain and escalate information to secure timely responses from insurers.

Skills

Customer service

Education

LPN License (Louisiana)

BLS Certification

MOAB Certification

Job description

Prior Authorization Specialist (Franklin, LA)

PRIMARY FUNCTION
The primary function of the Prior Authorization Specialist is to support the physician and interdisciplinary team in facilitating patient care with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. .

RESPONSIBILITIES AND ACCOUNTABILITIES

• Efficiently obtain authorizations for procedures to be performed prior to patients being scheduled.
• Verify insurance for in-network or out-of-network eligibility and benefits.
• Pre-certify services include surgery, office visits, diagnostic testing, and any procedure that requires authorization.
• Maintain referral and authorization record documentation.
• Consult with physicians, nurses, staff and providers regarding the referral and pre-certification process.
• Monitor outstanding authorization requests and initiate follow up of outstanding authorizations in a timely manner.
• Prepare and submit appeals on behalf of patients. Accept, handle, and process incoming patient telephone inquiries using appropriate customer services skills.
• Assists in routine clerical functions such as faxing, scanning, and updating patient records.
• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and authorizations.
• Obtain prior authorizations; initiate request, follow up to provide additionally required information, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed.
• Review for accuracy of prescribed treatment regimen prior to submission of authorization.
• Facilitate appeals process between the patient, physician and insurance company if needed.
• Composes clinical appeals letters based on specific denial reason and patients’ clinical presentation.
• Ensures all clinical information and documentation are obtained prior to appeal submission.
• Completes status check with insurance company regarding receipt of prior authorization and appeal and approval or denial.
• Track, report, and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay services.
• Works closely with Clinic staff, Admitting, Case Management, and Surgery Department.
• Performs other related duties as requested or assigned.

EDUCATION/QUALIFICATIONS/EXPERIENCE

• Requires an LPNLicense in the State of Louisiana.
• BLS Certification required upon hire.
• MOAB Certification preferred

Equal Employment Opportunity Statement

It is the policy of Bayou Bend Health Systemto provide equal opportunity to all employees and applicants without regard to race, color, religion, national origin, sex, age, disability, or any other regard as required by law.

This policy relates to recruitment, employment, placement, layoffs and recall, promotion/demotion, discipline, transfer, termination, rates of pay and/or all other forms of compensation, training and development, use of facilities, and participation in hospital sponsored activities.

Drug Testing

Bayou Bend Health Systemis an alcohol and drug free workplace. As a condition of employment all candidates must undergo and pass a post-offer drug screen. Failure to participate in the mandatory drug screen will void all offers of employment.

Department: 103 - PHYSICIAN CLINIC

This is a full time position

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