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Preauthorization Specialist - Community Physicians Clinic
Job Summary: Responsible for obtaining prior authorization for all procedural orders by successfully completing the authorization process with all commercial payers. Professionally and courteously greet and assist patients and pharmaceutical reps in person or on the phone to provide each patient assistance with insurance authorizations on medication for coverage under their plan. Work with other offices and their teams to accurately obtain information needed to process medication prior authorization requests from insurance carriers.
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Duties and Responsibilities:
Precertification Specialist
Review chart documentation to ensure patient meets medical policy guidelines.

Prioritize incoming authorization requests according to urgency.

Obtain authorization via payer website or by phone and follow up regularly on pending cases.

Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.

Initiate appeals for denied authorizations.

Respond to clinic questions regarding payer medical policy guidelines.

Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.

Contact patients to discuss authorization status.

Prescription Prior Authorization Specialist
Greet patients, pharmaceutical and insurance representatives in a positive and helpful manner. Work with them to obtain information necessary for medication coverage.

Communicate clearly in person and on the phone to establish/maintain cooperative relationships with patients, families, physicians, staff, and management.

Provide necessary forms to patients for completion and signature. Review all forms for completeness and accuracy.

Verify patient’s pharmacy insurance eligibility.

Effectively utilize the EMR, as well as, online authorization sites for medication programs, I.C. CoverMyMeds

Copy, fax, and email documents and information as requested by insurance carrier.

Establish and maintain effective working relationships with patients, providers, team members, insurance companies, and the public.

Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient’s rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Clinic Manager in a timely manner. Provide safe patient-centered, compassionate, and competent care.

Ability to interact with diverse groups.
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Professional Requirements

High school graduate or equivalent GED.

Experience and working knowledge of medical terminology and good customer service skills required.

2 years of medical prior authorization experience preferred. 2 years of medical office experience preferred.

Skills:

Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle.

Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.

Basic understanding of human anatomy, specifically musculoskeletal.

Proficient use of CPT and ICD-10 codes.

Excellent computer skills including Excel, Word, and Internet use.

Detail oriented with above average organizational skills.

Plans and prioritizes to meet deadlines.

Excellent customer service skills; communicates clearly and effectively.

Ability to multi-task and remain focused while managing a high-volume, time-sensitive workload.

Additional Information
Position Type : Full Time
Shift : Day

Contact Information
Jessie Schneider - HR
Community Memorial Healthcare
708 N 18th St
Marysville, KS 66508
Email: jaschneider@cmhcare.com
Phone: 785-562-4382
Fax: 785-562-2348

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