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Prior Authorization Specialist

Job ID: 2403039402-0 Date posted: 12/10/2024 Facility: TPR/CPM Staff

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Job Details

Responsibilities:

The Prior Authorization Specialist responsibilities may include, but are not limited to:

1. Applying medical knowledge and experience for prior authorize requests

2. Performing detailed medical reviews of prior authorization request or assessment forms according to established criteria and protocols

3. Managing incoming authorization requests and inquiries via fax, computer, telephone, or mail

4. Maintaining accurate documentation on all requests and documenting in the appropriate computer application

5. Initiating direct communication with health care providers involved with the care of the member to obtain complete and accurate information

6. Identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services.

7. Determining if services are a covered benefit and documents pre-authorization information in EMR.

8. Serves as a resource to clients

9. Performs other duties as requested or assigned

10. This role excludes performing any clinical tasks related to patient, to include assessment or evaluation of patient’s medical condition or providing clinical advice or medical care or recommendations

11. Demonstrated knowledge of potential exposure to hazardous materials (i.e. patient body fluids, disinfectant chemicals) and location of SDS sheets

12. Participates in QAPI and Safety Program

Qualifications

Education: High school education or equivalent. Associates degree preferred

Experience: At least one year in Scheduling in a healthcare environment is required

Tenet Healthcare/TPR complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

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Description

De la Pena Eye Clinic

The primary function of the Prior Authorization Specialist position is to provide premier customer service to the patient, physician and their office staff by obtaining facility authorizations for patients scheduled at the practice.

The Prior Authorization Specialist is responsible for reviewing prior authorization requests and following and established process.
This position manages a high call volume of prior authorization services.
The position reviews schedules with multiple patient's appointments, verifies or obtains authorization and document authorization information.
Communicate authorizations and denials to ordering physicians.
Keep records of schedules and authorization requests.
The person who fills this position is required to maintain a working knowledge of Managed Care Contracts as well as insurance requirements for authorizations, notifications or referrals.

2403039402

Pay Range: $23.00- $34.80 hourly **Individual wages are determined based upon a number of factors including, but not limited to, an individual’s qualifications and experience

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.

E-Verify: http://www.uscis.gov/e-verify