Centralized Prior Authorization Specialist

Primary Care Partners   Grand Junction, CO   Full-time     Administration / Clerical
Posted on July 28, 2022

Primary Care Partners has full-time openings for multiple Centralized Prior Authorization Specialists. The primary responsibility of the Centralized Prior Authorization Specialist is responsible for processing and submitting authorizations and ensures that all referrals and authorizations documents are completed and submitted in a timely manner. Communicate authorization denials to ordering physician. The Pre-Authorization Specialist is a member of the Pre-Authorization Team who is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services/studies. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care. The Pre-Authorization Specialist provides detailed and timely communication to both payers and care teams in order to facilitate compliance with payer requirements and is responsible for documenting the appropriate information in the patient's record. The starting pay for this position is $16.25 an hour. PCP pays for 100% of the employees’ health insurance which is a monthly $684 benefit. This benefit equals to an additional $4.27 an hour.

Duties and Responsibilities: • Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt. • Successfully works with payers via electronic/telephonic and/or fax communications. • Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services. • Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits. • Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review. • Communicates with patients, care team, financial counselors, and others as necessary to facilitate authorization process. • Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Completes accurate documentation of Auth/Cert. • Completes notification to all payers via electronic/fax/telephonic means per policy. • Ensures timely and accurate insurance authorizations are in place prior to services being rendered. • Follows departmental policies and procedures when necessary authorization is not obtained prior to service date. • Answers provider, staff, and patient questions surrounding insurance authorization requirements. Discuss any insurance communication with patient or family members

Work Experience: • Must have at least two (2) years of experience in the medical field and a minimum of one (1) year experience working with insurance companies. Up to one year of billing experience preferred. Education Requirements: • High School Diploma or GED We offer excellent benefits including Medical, Dental, Vision, Paid Time Off, 401K, Employee Assistance Program, competitive wages, friendly work environment and more.