Prior Authorization Specialist — Streamline Patient Care

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

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