Prior Authorization Specialist - FT bei GIBSON AREA HOSPITAL

Description

JOB TITLE:    SURGICAL/SPECIALTY PRIOR AUTHORIZATION REPRESENTATIVE

DEPARTMENT:  PRIOR AUTHORIZATION

GENERAL SUMMARY

To obtain prior authorization from multiple insurance companies before services are rendered for advanced radiology and surgeries for patients. Prioritizing incoming prior authorization task in order of importance/er stats.  Meet turnaround times for authorization guidelines.  Arranging peer to peer cases for denied cases with providers. Collaborating with depts./clinics to ensure all medical documentation is received prior to submitting authorization as well as CPT coding information.  Initiates and completes appeals process for denied services.  Documentation authorization and progression of authorizations.

GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT

To provide personalized, professional healthcare services to the residents of the Communities we serve.

PRINCIPLE DUTIES AND RESPONSIBILITIES

Obtain prior authorization for advance imaging, outpatient procedures and surgeries for the organization

PHYSICAL REQUIREMENTS

1.    Requires sitting for long periods of time; also stooping, bending, and stretch for files and supplies. Occasionally lifts files or paper weighing up to 20 to 30 pounds.

2.    Requires manual dexterity sufficient to operate a keyboard, type at 40 wpm minimal, operate a calculator, telephone, copier, and such other office equipment as necessary.
 
3.    Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts.

4.    It is necessary to view and type on computer screens for long periods and to work in an environment which can be very stressful.

5.    Auditory acuity to hear others for purposed of fluent communication.

6.    Physical strength to perform the following lifting demands:
•    Floor to waist – 20 pounds
•    14” to waist – 30 pounds
•    Waist to shoulder – 20 pounds
•    Shoulder to overhead – 10 pounds
•    Carry 20 pound 30 feet
•    Push 10 pound/force for 15 feet
•    Pull 10 pounds/force for 15 feet

REPORTING RELATIONSHIP

Reports to manager
 

Qualifications

EDUCATION, KNOWLEDGE AND ABILITIES REQUIRED:

HS Diploma, Insurance knowledge and medical terminology preferred, 1-2 years of working medical and/or insurance field preferred, knowledge working in excel preferred, excellent verbal and written communication skills

INFECTION EXPOSURE RISK LEVEL 

Zero-Low

WORKING CONDITIONS

Office setting