Prior Authorization Specialist - Sheboygan, WIPrevea Health • Sheboygan, WI, United States
Prior Authorization Specialist - Sheboygan, WI
Prevea Health • Sheboygan, WI, United States
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High School Diploma and / or GED Required 1-3 years One year of experience in a medical or insurance role Required Display proficient telephone and computer skills with clear and professional speaking abilities. Excellent organizational skills. Excellent communication skills and follow through with internal and external customers. Knowledge of insurance and medical terminology. Basic knowledge of current CPT / ICD coding. Able to provide exceptional customer service by assessing patient needs, meeting quality standards, and evaluating satisfaction. Capable of being empathetic and responsive to patient's needs by actively listening, asking appropriate questions, and continually looking for ways to provide assistance. Able to efficiently multi-task and adapt to fast-paced environments with frequently changing protocols and processes. Capable of effectively and positively interacting with staff members throughout the company. Promote teamwork and provide a supportive environment throughout the organization. Display grammar, spelling, and punctuation knowledge to accurately document patient information. Able to work independently and think critically using provided information. Sit - Constantly Stand - Rarely Walk - Rarely Drive - Rarely Climb (Stairs / Ladders) - Rarely Bend (Neck) - Frequently Gross Manipulation (Hands / Arms) - Constantly Squat - Rarely Twist / Turn (Neck) - Occasionally Lift / Carry 0-10 lbs. - Rarely Lift / Carry 11-25 lbs. - Rarely Lift / Carry 26-35 lbs. - Rarely Push / Pull up to 10 lbs. - Rarely Push / Pull 11-25 lbs. - Rarely Push / Pull 26-35 lbs. - Rarely Reach (Above shoulder level) - Rarely Reach (Below shoulder level) - Constantly Simple Grasping (Hands / Arms) - Constantly Fine Manipulation (Hands / Arms) - Constantly Gross Manipulation (Hands / Arms) - Constantly Noise - Occasionally 5% Hears Whispers Hears Whispers 3-8 feet - Constantly Color Discrimination - Constantly Near Vision (Correctable to Jaeger 2 or 20 / 40 binocular) - Constantly Distance Vision (Correctable to Snellen chart 20 / 40 binocular) - Constantly
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Prior Authorization Specialist
#25-583
Sheboygan, Wisconsin, United States
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Location
Sheboygan MOB-028
Description
This position is full-time, 40-hours per week. It is full-time benefit eligible.
Prior Authorization Specialist
Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.
Job Summary
The Prior-Authorization Specialist at Prevea Health is responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, services and medications. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist will collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals.
What you will do
- Identify and obtain what is required for preauthorization of procedures, diagnostic tests, services and medications. Seeing the process through completion to minimize denial of claims.
- Coordinate with department providers and staff, coding / billing staff, and insurance representatives to ensure understanding of information needed to obtain proper authorization for payment within the appropriate timelines.
- Review and interpret insurance coverage and policy guidelines to determine authorization requirements.
- Communicate with patient as needed for procedures, diagnostic tests, services and medications to provide them with information regarding their coverage.
- Accurately document and communicate final determination in the patient's medical record and to appropriate staff, providers, or patient.
- Work with internal teams to identify and address trends or issues in the prior authorization process.
- Provide feedback and recommendations to improve prior authorization workflows and efficiency.
Education Qualifications
Experience Qualifications
Skills and Abilities
Physical Demands
Working Conditions
Travel Requirements
Hearing Requirements
Vision Requirements
Prevea is an Equal Employment Opportunity / Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov / E-Verify
Position Located In
Sheboygan,WI
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Prior Authorization Specialist • Sheboygan, WI, United States
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