Prior Authorization Specialist Primary

Prevea Health; Green Bay (WI); On-site; USD 38,000 - 60,000; Full time

Job summary

Prevea Health is seeking a Prior-Authorization Specialist to obtain and verify authorizations within the applicable timeline for procedures, diagnostic tests, services and medications, ensuring all requests comply with insurance policies, guidelines, and healthcare regulations.

The specialist will collaborate with providers, patients and insurance representatives to obtain the necessary approvals, document final determinations in the medical record, and support efficient workflows and quality

Qualifications

• High School Diploma and/or GED.
• 1–3 years of experience in a medical or insurance role.

Responsibilities

• Identify and obtain preauthorization of procedures, diagnostic tests, services and medications. Seeing the process through completion to minimize denial of claims.
• Coordinate with department providers and staff, coding/billing staff, and insurance representatives to ensure understanding of information needed to obtain proper authorization for payment within the appropriate timelines.
• Review and interpret insurance coverage and policy guidelines to determine authorization requirements.
• Communicate with patient as needed for procedures, diagnostic tests, services and medications to provide them with information regarding their coverage.
• Accurately document and communicate final determination in the patient’s medical record and to appropriate staff, providers, or patient.
• Work with internal teams to identify and address trends or issues in the prior authorization process.
• Provide feedback and recommendations to improve prior authorization workflows and efficiency.

Skills

Telephone skills

Computer skills

Organizational skills

Communication skills

Insurance terminology

Medical terminology

CPT/ICD coding

Education

High School Diploma and/or GED

Job description

JOB REQUIREMENTS:

This position will work 40 hours per week Prior

Authorization Specialist

Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they’re our employees. We’re an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.

Job Summary

Prior-Authorization Specialist at Prevea Health is responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, services and medications. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist will collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals.

What you will do

• Identify and obtain what is required for preauthorization of procedures, diagnostic tests, services and medications. Seeing the process through completion to minimize denial of claims.
• Coordinate with department providers and staff, coding/billing staff, and insurance representatives to ensure understanding of information needed to obtain proper authorization for payment within the appropriate timelines.
• Review and interpret insurance coverage and policy guidelines to determine authorization requirements.
• Communicate with patient as needed for procedures, diagnostic tests, services and medications to provide them with information regarding their coverage.
• Accurately document and communicate final determination in the patient’s medical record and to appropriate staff, providers, or patient.
• Work with internal teams to identify and address trends or issues in the prior authorization process.
• Provide feedback and recommendations to improve prior authorization workflows and efficiency.

Education Qualifications

• High School Diploma and/or GED

Required Experience Qualifications

• 1-3 years of experience working in a medical or insurance role

Required Skills and Abilities

• Display proficient telephone and computer skills with clear and professional speaking abilities.
• Excellent organizational skills.
• Excellent communication skills and follow through with internal and external customers.
• Knowledge of insurance and medical terminology.
• Basic knowledge of current CPT/ICD coding.
• Able to provide exceptional customer service by assessing patient needs, meeting quality standards, and evaluating satisfaction.
• Capable of being empathetic and responsive to patient’s needs by actively listening, asking appropriate questions, and continually looking for ways to provide assistance.

Prevea is an Equal Employment Opportunity/Affirmative Action employer *****