JOB SUMMARY (overview of job): The primary function of the Prior Authorization Specialist position is to provide premier customer service to the patient, physician and office staff by obtaining facility authorizations for patients scheduled at SPH. This position will be required to verify insurance coverage and obtain insurance authorizations. The Specialist is required to maintain a working knowledge of all Managed Care Contracts as well as insurance requirements and policies for authorizations, notifications and/or referrals. The Specialist position will utilize the system functionality as well as office equipment such as a scanner, credit card terminals and fax machine. This position will be in communication with outside physician offices and ancillary departments within the hospital to complete an accurate patient record.

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

• Applying medical knowledge and experience for prior authorization requests;

• Performing detailed medical reviews of prior authorization requests or assessment forms according to established criteria and protocols;

• Managing incoming authorization requests and inquiries via fax, computer, telephone, or mail;

• Maintaining accurate documentation on all requests and documenting in the appropriate computer application;

• Initiating and continuing direct communication with health care providers involved with the care of the member to obtain complete and accurate information;

• Serving as a resource to clients;

• Exercising the ability to complete additional duties as needed.

KNOWLEDGE/EXPERIENCE:

• Sufficient experience to demonstrate ability to accept responsibility as a Hospital and Clinic prior authorization representative.

• Knowledge of anatomy and physiology, medical terminology and disease processes.

• Proficient keyboard skills and working knowledge of computer required.

• Good verbal and written communication skills.

• Cognitive, organizational and emotional abilities to deal effectively with multiple stressors, deadlines and customer needs.

EDUCATION: High school Diploma, HiSET or GED equivalent required. Completes Patient Financial Services I and training within first 5 months.

Aptitudes:

• Ability to achieve cognitive, organization and emotional maturity to deal effectively with multiple tasks, stresses, deadlines, difficult situations and/or customers.

• Possesses interpersonal/communication skills necessary for effective, non-judgmental, and empathetic patient care and customer relations.

• Open to feedback, and open to a changing environment, which requires flexibility in scheduling and department assignments.

• Create, maintain, and promote a respectful work environment consistent with SPH patient and employee satisfaction culture.

• Attention to detail and accuracy.

• Ability to accurately and efficiently document customer interactions.

Possess a customer-focused mindset

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