Prior Authorization Specialist

Full Job Description

Advanced Reconstructive Surgery Alliance (ARSA) and its affiliates TPSC, SMM and TCOPS are the largest Plastic Surgery medical practice in the country. Our expanding team of top tier physicians, coupled with our continued medical advancements, allows us to offer patients extraordinary clinical services with 5-star experience. We have a bold vision with a desire to revolutionize the industry; meeting patient needs while favorably transforming their lives. Common across the enterprise is not only the commitment to providing safe patient care, but to employee satisfaction and growth opportunities. It is a culture of teamwork, respect and appreciation for all employees—whether caring for patients directly or working in a support role.

We are seeking a Prior Authorization Specialist to join our team.

Responsibilities:

• Obtain and/or verify patient insurance benefit coverage by use of insurance websites, such as Navinet, or by contacting the insurance carriers prior to patient appointment. Clearly document details of the verification for service reference.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Request, follow up and secure prior-authorizations prior to services being performed.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Communicate any insurance changes or trends among team.
• Maintains a level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
• Prioritize the incoming authorizations by level of urgency to the patient
• Communicate with medical providers and other staff members about any patient concerns and/or issues related to verification.
• Knowledge of medical terminology.
• Ability to build and maintain strong relationships with insurance representatives.
• Ability to work effectively with physicians and other medical staff.
• Maintain patient and company confidentiality.

Requirements:

• High School Diploma or equivalent
• Two years of experience in a health care environment
• Knowledge of Out of Network providers highly preferred
• Experience with insurance authorizations preferred
• Excellent verbal and written communication skills.
• Excellent organizational and business office skills.
• Goal and detail-oriented and able to perform successfully in a fast-paced environment

Compensation & Benefits:

· · Pay Range: $22-$25 an hour

the starting rate within this range for this role varies depending on a number of factors, including a candidate’s qualifications, skills, competencies, experience, and location.

· Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance

· 401k and Profit sharing

· Paid Time Off

· Mileage Reimbursement

· Contribution to Health Benefits

· Company Discounts on Products & Services

Job Type: Full-time

IND2

Job Type: Full-time

Pay: $22.00 – $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Have you previously worked for us in any capacity?

Experience:

• prior authorization: 3 years (Required)

Ability to Commute:

• Red Bank, NJ 07701 (Required)

Work Location: In person