The Prior Authorization Specialist is responsible for all aspects of the prior authorization process including, but not limited to: verifying insurances, ensuring that prior authorizations are obtained prior to procedures, and auditing the validity of past prior authorizations on file. Individual must possess an understanding of medications, insurances and medical terminology. RESPONSIBILITIES Confirms that prior authorization has been obtained in a timely manner prior to the service date for surgeries, on-site MRI, pain management procedures and Ultrasound-Guided injections. Audits the validity and accuracy of prior authorizations. Monitors the status and completion of assigned tasks to outside vendors. Provides up-to-date training and education of tasking process accordingly, adhering to CMS recommendations. Able to expedite and complete urgent authorization requests as needed. Documentation of Authorization number and valid dates in NextGen. Maintains constant and open communication with outside vendor to increase accuracy and efficiency of task completion. Able to explain patient financial responsibility if indicated. Other duties as assigned. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. QUALIFICATIONS Fundamental knowledge of anatomy. Advanced knowledge of Insurance, IPA and Authorization process. Experience in healthcare industry and patient scheduling. Workers\' Compensation knowledge preferred. Proficient with Microsoft Office and medical practice management software. Adheres to HIPAA, privacy, confidentiality and safety guidelines per office polices and protocol. Patient, empathetic, and compassionate. Meticulous attention to detail. Ability to work in a fast-paced environment while maintaining a positive attitude. Ability to meet deadlines and work under pressure with minimal supervision. REQUIREMENTS The individual MUST reside in Southern California This position requires onsite training at our office for the first 90 days. Upon successful completion of the training period, the role will transition to a fully remote work arrangement. Pay Range: $22.00-$25.00 per hour Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Newport Orthopedic Institute
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