Prior Authorization Specialist - Healthcare Operations

Brown University Health; Kingstown (MD); On-site; USD 26,000 - 43,000; Full time

Job summary

Brown University Health in South Kingstown, RI seeks an Insurance Prior Authorization Coordinator to ensure the integrity of the department's preauthorization workflow and coordinate visits, procedures, orders, and referrals with insurance companies.

Under supervision of the Practice Manager, you will verify CPT/ICD codes, obtain required documentation, and communicate with patients and providers to minimize denials and delays while upholding the hospital's standards of care and service.

Qualifications

• High school diploma or equivalency required.
• Post-secondary business program or equivalent preferred.
• Strong medical terminology knowledge.
• Ability to manage high volume of prior authorizations.
• Interpersonal skills to train and coach staff and interact with others.
• Analytical skills to evaluate workflow and suggest changes.
• Proficient computer skills and familiarity with networks.
• Ability to recognize clinical documentation relevant to authorizations.

Responsibilities

• Schedule peer-to-peer discussions to obtain prior authorization for denied services.
• Ensure orders are complete, legible, and scanned in the EMR.
• Coordinate information for managing insurance denials.
• Participate in team meetings to identify problems and improvements.
• Review referrals and pre-authorizations to ensure proper authorization.
• Train staff on policy changes and adherence to procedures.
• Confirm patient eligibility and obtain visit authorizations as needed.
• Provide mature, quality customer service to patients and families.
• Coordinate with outside agencies to obtain patient information when needed.
• Contact third-party payers for required pre-authorizations per policy.
• Respond to inquiries from patients, physicians, and labs/radiology.
• Collaborate to resolve billing issues and denials; perform write-offs as needed.

Skills

Medical terminology

Prior authorization

Organizational skills

Analytical skills

Customer service

Communication

Computer skills

EMR systems

Education

High school diploma

One-year post-secondary business program

Tools

EMR systems

Job description

Brown University Health in South Kingstown, RI seeks an Insurance Prior Authorization Coordinator to ensure the integrity of the department's preauthorization workflow and coordinate visits, procedures, orders, and referrals with insurance companies.

Under supervision of the Practice Manager, you will verify CPT/ICD codes, obtain required documentation, and communicate with patients and providers to minimize denials and delays while upholding the hospital's standards of care and service.