Prior Authorization Processor

Description

Pay Range: $17.04 - $25.55 Job Description: The Prior Authorization Processor is a Full Time, Regular position working remotely Monday-Friday from 8am-5pm. Ideal candidate will reside in our service area of Oregon, Idaho, Montana, Washington. Summary: Prior Authorization Processor is responsible for monitoring and acting on requests from our clients for prior authorization. The Prior Authorization Processor provides support by assessing Insurance verification, determining if there is need for prior authorization, submitting all information and documentation to the insurer, following up with insurer if more information is needed, coordinating with the client and patient to gather additional information, monitoring the status of the request and documenting approval in the client’s EMR. The position requires a highly organized, motivated and a skilled problem solver. Attention to detail and strong customer service skills to ensure all necessary steps are taken to accurately identify or process a request for a prior authorization. Essential Duties / Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Provides high quality customer service by:
  • Communicates by asking the appropriate questions to get information necessary to verify if an authorization is required and if so enough information to help process the request.
  • Completes phone call with a professional closing
• Determines when an authorization/referral is required
• Obtains any information necessary to assist with the authorization process
  • Call Client staff, patients and referring physician office when necessary
• Understands the billing process to identify and communicate the codes and forms that may be required to ensure reimbursement.
• Identifies faxes from prior authorization fax server sent in by referring providers and renames with standard nomenclature
• Adds and verifies patient current insurance information and verifies any changes indicated as part of the insurance look-up process on our internal system. Updates this information when needed.
• Keeps all on-line web portals accounts active to ensure access is maintained in order to obtain prior-authorization verification.
• Maintains a working knowledge of supplemental programs (Recondo and Payer websites)
• Demonstrates appropriate verbal and written communication skills to relay accurate information in a clear, concise manner to peers, staff, management, and patients.
• Initiates appropriate questions and provides timely feedback to lead and management on any issues, policies, and procedures, etc.
• Organizes and maintains records to provide accurate reporting, easy access to information and historical data.

• Acts as a liaison between staff, management, and client.
• Identifies and reports any Payer updates or changes that may be encountered when working accounts to Team Lead.
• Identifies and reports any changes or updates to Payer web portals used in prior authorization process that may be encountered when working accounts to Team Lead
• Provides a Bi-weekly or monthly report out of identified issues or concerns regarding payers, system workflow or referrers.
• Maintains the prior authorization resource portal by updating referring office contact information.
• Maintains the prior authorization issue log in smartsheet for tracking payer, billing, referring office or other issues to be reviewed and followed-up on by the Team Leader.
• Performs other duties as assigned.

General Duties/Responsibilities:

• Ability to maintain strict confidentiality within the CBO, clients, and patients.
• Follows all Health and Safety policies and guidelines of CBO or its partners depending on work location.
• Follow all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.
• Follows all policies regarding HIPAA, non-disclosure of confidential information and company security.
• Honest, pleasant manner and good personal hygiene.
• Free of alcohol and drug abuse.
• Valid state driver’s license and proof of insurance.
• Excellent communication and interpersonal skills.
• Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.
• Demonstrates self-directed learning and participation in continuing education through professional journals, approved seminars, etc.
• Ability to consider individual needs in communication with and assessment and treatment of patients of all ages.

• Adheres to departmental standards and personnel policies by demonstrating professional demeanor in conduct and appearance.
• Follows company departmental standards and personnel policies by using good teamwork and communication skills to help identify concerns and solutions, assisting where needed to ensure a smooth functioning department.
• Performs other duties as required by displaying team spirit and self-growth, accepting and performing other projects and responsibilities, and requesting other projects and responsibilities.
• Attendance is required for this position.

Supervisory Responsibilities:

• There is no supervisory responsibility in this position

Advocacy: Treats all patients with dignity and respect Provides excellent customer service Conforms to Joint Commission and HIPAA regulations Complies with PHI (Protected Health Information) Demonstrates the Inland Imaging Core Values

• Show We Care, Do The Right Thing, Maximize Individual Potential, Always Aim Higher

Qualifications:

• Education: High School Diploma/GED required
• Experience: One year of previous scheduling, insurance or medical office experience required
  • Proficient and accurate with electronic health systems including applications of billing, pre-authorizations, demographics and coding preferred
  • Anatomy and medical terminology preferred
  • Medical office experience preferred
  • Knowledge of coverage and requirements for private insurances, commercial insurance and government payers. Demonstrated experience using software applications for Electronic Medical Records preferred
  • Understanding of procedures to be read by radiologist preferred
• Licensure: N/A
• Certifications: N/A
• Computer Skills: Experience with the following computer applications is highly desired: Microsoft office products and a strong understanding of internet related access, Workday, Qgenda
• Background Check:
  • Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults
  • In order to comply with provisions set forth in Sections 1128 and 1156 of the Social Security Act, all new employees of Inland Imaging Clinical Associates, LLC will be checked against the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG). Employees must not be included on this list.
• Drug Test: Eligible employees must be able to pass a post-offer, pre-employment drug test which includes marijuana.

Nuvodia/Inland is an EEO employer...