Prior Authorization Specialist — Flexible Schedule

Refuah Health Center Inc; Village of Spring Valley (NY); On-site; USD 25,000 - 34,000; Full time

Job summary

Refuah Health is seeking a Prior Authorization Specialist to obtain pre-certifications and authorizations for patients. It is a federally qualified health center with three decades of experience providing accessible care in Rockland and Sullivan Counties.

You will contact insurers, collaborate with providers to resolve denials, verify benefits, and pre-certify services, while maintaining authorization records.

Qualifications

• High School Diploma required.
• Knowledge of healthcare insurance carrier regulations.
• Prior experience as a Medical Assistant is preferred.
• Willingness and ability to quickly learn new software systems and workflows.
• Good interpersonal and communication skills.
• Ability to project a pleasant and professional image.
• Ability to effectively manage conflicts and resolve problems.

Responsibilities

• Contact insurance companies to verify benefits eligibility.
• Collaborate with Refuah providers to resolve and appeal denied authorizations.
• Ensure all services have prior authorizations.
• Utilize EMR system when reviewing encounters and assigning to providers.
• Maintain knowledge of Medicaid and third-party insurance requirements.
• Verify insurance for in-network or out-of-network benefits.
• Pre-certify services including surgeries, visits, or tests requiring pre-certification.
• Review pediatric referrals and help schedule appointments.
• Maintain authorization records and documentation.
• Comply with policies and support the Compliance Program.
• Contribute to organizational operations by performing other duties as required.

Skills

Interpersonal communication

Conflict resolution

Detail-oriented

Willingness to learn software

Education

High School Diploma

Tools

EMR system

Job description

Refuah Health is seeking a Prior Authorization Specialist to obtain pre-certifications and authorizations for patients. It is a federally qualified health center with three decades of experience providing accessible care in Rockland and Sullivan Counties.

You will contact insurers, collaborate with providers to resolve denials, verify benefits, and pre-certify services, while maintaining authorization records.