The Prior Authorization Specialist reports directly to the Director of Ambulatory Operations and is responsible for ensuring accurate and timely prior authorizations for specialty medications. Investigate benefit information, confirm if an authorization is required, and obtain authorization as needed from insurance companies Effectively communicate with third party payers, Holzer Specialty Pharmacy, Revenue Cycle and ordering departments to assure medications are authorized correctly for the location they will be administered. Exhibit proven ability to make logical, intelligent decisions independently with minimum supervision.

 

Education, Work Experience, Skills and Licensure:

 

1. High school diploma or GED with 2 years of college or professional school preferred.

 

2. Minimum of 2 years’ experience in the medical field or 1 year experience in medical authorization/precertification preferred.

 

3. Basic knowledge of ICD 10 and CPT codes.

 

4. Accuracy in data entry and thorough review of medical records to ensure complete and accurate submission of authorization requests.

 

5. Familiarity with electronic health records (EHR) systems and insurance company portals for submitting authorization requests.

 

6. Knowledgeable in medical terminology, anatomy, and physiology.

 

7. Computer/PC aptitude.

 

8. Familiarity with different insurance plans, benefit structures, and prior authorization requirements.

 

9. Highly developed attention to detail and organization skills critical; ability to work independently, manage multiple tasks and meet deadlines.

 

10. Above average interpersonal communication skills required.

 

11. Strong problem-solving skills.

 

12. Ability to write professional correspondence via letter or email.

 

13. Ability to work with confidential information.

 

14. Working knowledge of business equipment (facsimile, copier, printer, etc.).