Prior Authorization SpecialistChildren's Clinics for Rehabilitative Services • Tucson, AZ, US
Prior Authorization Specialist
Children's Clinics for Rehabilitative Services • Tucson, AZ, US
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]Reviews future appointments in NextGen on a daily and weekly basis to verify that all required authorizations have been requested, paying close attention to short notice and same day appointments Reviews patient information including diagnosis ICD10 codes, CPT codes and submits authorization request and all required documentation to the appropriate insurance companies Track pending authorizations, follow up on submitted authorizations Processes approved / denied requests with accuracy and meeting timely standards to include data-entry, coordination with offsite providers and clinical staff for scheduling and communication of status and requests Performs other duties as required and assigned Knowledge of AHCCCS, CRS, and private insurance guidelines Knowledge of precertification, referrals, and prior authorization Knowledge of medical terminology, CPT, and ICD-10 codes and practices Skill and proficiency in using Microsoft Office Suite Ability to maintain confidentiality of patient, personnel, and corporate data Ability to cross reference data to assure accuracy and completeness Ability to post information to electronic records and maintains the electronic file and any manual files Ability to effectively manage time with a proven ability to meet deadlines; organization and attention to detail Competent using a Practice Management System Ability to communicate effectively, both verbally and in writing with patients, their families and all levels of personnel. Demonstrates tact and understanding when dealing with patients, families, and staff Ability to maintain confidentiality of patient data according to HIPAA regulations Ability to operate personal computer and related office equipment as needed to perform job functions
SUMMARY
This position is responsible for exercising independent judgment to process referrals and prior authorizations administration.
All referrals and prior authorizations will be processed according to the appropriate insurance.
This position is responsible for both on- and off-site services for multiple providers including Primary care, Specialty providers, Dental, Therapies including Physical, Occupational, Speech Therapy and Audiology.
ESSENTIAL FUNCTIONS
- Appropriately prioritize all prior authorization request / referrals.
Submits for onsite and offsite appointments, outpatient procedures, diagnostics procedures and / or therapies
KNOWLEDGE, SKILLS AND ABILITIES
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Prior Authorization Specialist • Tucson, AZ, US
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