Keystone Advisors is looking for a Prior Authorization Specialist to join our team in Matteson, IL supporting one of our healthcare clients.
Job Summary
The Prior Authorization Specialist is responsible for obtaining and processing all prior authorization requests, coordinating phone calls, entering and tracking data from insurance providers and health plans regarding authorization, expedited reviews, and appeals. The Prior Authorization Specialist is required to document and track all communication attempts with insurance providers and health plans, follow up on all denials while working to ensure services are validated.
Typical Duties
Reviews accounts, and initiate pre-authorizations, and other requirements related to managed care; route to appropriate departments as needed. Collects demographic, insurance, and clinical information to ensure that all reimbursement requirements are met. Notifies the necessary parties within the required timeframe for routine and urgent requests for services. Assists in monitoring utilization services to assure cost effective use of medical resources through processing prior authorizations. Communicates with patients and/or referring physicians on non-covered benefits or procedure coverage issues. Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Provides consistent and comprehensive information (both in writing and verbally) to facilitate approvals. Ensures insurance carrier documentation requirements are met and authorization documentation is entered and recorded in the patient's records. Appeals pre-authorization denials and/or set-up peer to peer reviews. Maintains an extensive working knowledge and expertise of insurance companies and billing authorization requirements. Identifies and reports undesirable trends and reimbursement modeling errors or underlying causes of incorrect
