Prior Authorizations Specialist - General Surgery

Hartford HealthCare; Trumbull (CT); On-site; USD 42,000 - 65,000; Full time

Job summary

Hartford HealthCare is seeking a Prior Authorization Specialist in Trumbull to obtain insurance authorizations for in-office procedures and surgical services. Under the direction of the Manager, you will maintain resources and EPIC documentation, and access insurance portals as needed.

You will monitor authorizations, contact insurers, document details, inform providers of denials, collaborate with pharmacy on plan drug choices, and support billing and front desk tasks as required.

Qualifications

• High School Diploma preferred.
• Experience with insurances and prior authorizations.
• Experience communicating with physicians, staff, patients and insurers.

Responsibilities

• Monitor and verify insurance information and pre-authorization requirements for procedures.
• Contact insurers to obtain prior authorization via phone or portals.
• Document authorization details in EPIC.
• Notify providers of denials and support peer-to-peer reviews.
• Collaborate with pharmacy on preferred drugs for insurance plans.
• Maintain log of missed authorizations and assist with appeals.
• Coordinate with hospital departments on billing and policies related to prior authorizations.
• Assist in front desk duties when time allows.
• Manage referral work queue and scheduling support.

Skills

Communication

Customer service

Organization

Telephone skills

Computer skills

Education

High School Diploma

Tools

EPIC

Job description

Location Detail: 115 Technology Dr Trumbull (10432)

Shift Detail: Monday -Friday 8:00 am - 4:30pm

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

Hartford HealthCare Medical Group is one of the largest medical practices in New England with multiple locations throughout Connecticut and Rhode Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group enjoys an excellent reputation with patients and the medical community, offering primary care, urgent care and more than 30 different specialties.

Job Description

Under the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain insurance prior authorizations for all in office procedures, and any surgical services in a timely manner. Responsible for creating, maintaining and managing resources, including insurance portal access. Must have consistent documentation in EPIC to support the obtained insurance authorization. Will communicates changes in payer and or federal regulatory guidelines to their manager, providers and other clinical departments, as applicable.

• Monitors and reviews the prior authorization work queue daily to verify accuracy of patient’s insurance information and to interpret insurance pre-authorization requirements for scheduled procedures.
• Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled date of procedure.
• Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.
• Immediately communicates to provider when a procedure, or surgery is denied by the insurance company. Assists in setting up peer to peer reviews
• Collaborates and communicates with pharmacy regarding preferred drugs on the particular insurance plan and notifies providers of alternatives
• Maintains log of missed prior authorizations and assists manager with timely retro authorizations or appeals to recoup revenue.
• Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.
• When time allows can help out in the office with managing incoming phone calls, baskets and other front desk coverage, answering phones and transcribing orders and referrals.
• Monitoring referral work queue, registering arriving patients, answering incoming calls, surgical scheduling as well as other assigned duties as needed.

Qualifications

• High School Graduate/Diploma preferred
• At least one year experience working with insurances and prior authorizations, preferred
• Experience and knowledge of insurances and prior authorizations
• Ability to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companies
• Must be self-motivated and have the ability to work independently and within a team
• Demonstrates excellent telephone, computer, organization and customer service skills

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.