Prior Authorization Specialist

Responsibilities

Under the supervision of the Business Services Supervisor, the Prior Authorization Specialist (PAS) is responsible for processing incoming referral requests by contacting the Health plans verbally or electronically to obtain prior authorization for services provided and directed by a Kelsey provider. The PAS is responsible for communicating, obtaining and/or providing all required information to the health plans to facilitate the approval process, such as the medical record or an extract of clinical information from the medical record, and all pertinent information required to obtain prior authorization. The PAS also responsible for accurately verifying and/or documenting in the practice management system all pertinent information conducive to proper claim adjudication by the health plan, including, but not limited to authorization numbers, CPT codes approved, authorized dates, start and expiration date, call reference numbers, health plan representative?s first and last name, and payor portal screenshots. The PAS is responsible for initiating communication with the clinic/physician when a referral is denied and/or requires additional information, Peer to Peer Review, etc. The PAR is responsible for logging in to the designated phone queue to answer, direct and/or resolve any inquiries or directions regarding referrals. Additional duties include handling and appropriately directing referral status requests as needed. The PAS will also identify and report to the Management team any patterns, trends or workflow deficiencies that undermine department effectiveness. Other duties as assigned.

Job Title: Prior Authorization Specialist

Location: Pearland Administrative Office

Department: Business Office-Pre Auth & Claim Edits

Job Type: Full Time

Salary Range: $39,179 - $48,397 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

Qualifications

Education

Required: High School diploma or GED from an accredited program

Preferred: College level courses

Experience

Required: 2 years of medical office experience either in a physician office or hospital setting, health plan, ACO, or other managed care setting.

Experience navigating payor web portals

Preferred: Knowledge of CPT & ICD 10 Coding methodologies.

Prior experience with precertification and/or utilization management

License(s)

Required: N/A

Preferred: Epic System usage

Special Skills

Required: Working knowledge of medical terminology and HMO/ PPO authorization processes.

Excellent communication skills

Alpha/numeric data entry and basic PC Literacy

Good problem-solving skills.

Ability to handle a variety of tasks with speed, attention to detail and accuracy.

Preferred: N/A

Other

Required: Excellent time management skills to handle high workload volume.

Self-directed, attention to detail

Excellent interpersonal communications skills with ability to communicate effectively both orally and in writing with patients, physicians, management, and third-party representatives.

Ability to empathize with patients in need of care.

Preferred: N/A

Working Environment: Office/Medical Clinic

About Us

Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston's fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.

Why Kelsey-Seybold Clinic?

• Medical, Vision, and Dental

• Tuition Reimbursement

• Company Matching 401K

• Employee Reward and Recognition Program

• Paid time off for vacation, sick, and holidays

• Employee Assistance Program

• Continuing Medical Education allowance