Prior Authorization Specialist - Onsite

Refuah Health Center; 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

our privacy is important to us. All applications are strictly confidential.Refuah Health is a federally qualified health center offering comprehensive care in Rockland and Sullivan Counties. We are over one hundred healthcare professionals strong with three decades’ experience providing unparalleled patient care. As an FQHC, we specialize in accessible and affordable care for low income and high-risk residents. We believe in the power of people to create great care and we are inviting the best to build their career with us!Why Refuah?Join a collegial team of coworkers.Five modern state of the art facilities.Flexible schedules for maximum work-life balance.No Prior Authorization experience required. Full training provided.The Prior Authorization Specialist is responsible for obtaining pre-certifications and authorizations for Refuah patients. They take ownership and serve as the last line of defense against errors.Duties and responsibilities:Contact insurance companies to verify benefits eligibilityCollaborate with Refuah providers to resolve and appeal denied authorizationsEnsure all services have prior authorizations. Utilize EMR system checking encounters when necessary and assign to the appropriate provider.Maintain knowledge of Medicaid and third party insurance requirementsVerify insurance for in-network or out-of-network benefitsPre-certify services including surgery, office visits, diagnostic testing or any procedure that requires pre-certificationReview Pediatric referrals from previous day and help schedule appointmentsMaintain strict patient confidentialityMaintain authorization records documentationComplies with applicable policies and procedures and supports the Compliance ProgramContributes to organizational operations by performing other duties as may be requiredJob Requirements:High School DiplomaKnowledge of the health care field with regards to insurance carrier regulationsPrior experience as a Medical AssistantWillingness and ability to quickly learn new software systems and workflowsComfort with, and reliability in, performing repetitive or detail‑oriented (tedious) tasks accurately and efficiently.Good interpersonal and communication skillsAbility to project a pleasant and professional imageAbility to effectively manage conflicts and resolve problemsWorking Conditions and Physical Efforts:Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full motion of the lower extremities and back muscles.Reaching. Extending hand(s) and arm(s) in any direction.Standing. Particularly for sustained periods of time.Walking. Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.Pushing. Using upper extremities to press against something with steady force to thrust forward, downward or outward.Pulling. Using upper extremities to exert force to draw, haul or tug objects in a sustained motion.Talking. Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.Hearing. Perceiving the nature of sounds at normal speaking levels with or without correction. Ability to receive detailed information through oral communication, and to make out distinctions in sound.Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers.