Employment Opportunities

PRC/ CHS Authorization Specialist

This position has been filled.
Public?: 
Public
Division: 
Health
Reports To: 
Director of Purchase Referred Care
Type of Position: 
Regular Full Time
Location: 
Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
General Description
Responsible for completion of prior authorizations, pre-certifications, and notifications for all medical, specialties, pharmaceutical and diagnostic services. Utilizes a thorough working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize benefits. Responsible for documenting/providing notifications of delays or denials of pre-authorizations/pre-certification approvals. Responsible for all prior-authorization needed for referrals Tribal, Private Insurance and Indian Health Services (IHS) initiated by Absentee Shawnee Health System providers.  Responsible for processing provider driven referrals as assigned by the Case Manager/Department Director.
ResponsibilitIes
Determine necessity for pre-authorization in-house and out bound
Office visit specialties
Knowledge of requirements for prior authorizations including procedures,  medications,
Work with insurance to pre-certify/authorize the exam.
Ensures up-to-date documentation on patient’s accounts in Electronic Medical System on authorization approvals and denials. (Including approval dates, prior authorization number in patient profile.)
Review accuracy and completeness of information requests and ensure that they are properly and closely monitored.
Submit clinical supporting documentation to Insurance carriers to expedite prior authorization processes.
Manage correspondence with insurance companies, physicians and patients as required -AST, PVT Insurance and IHS
Look through denials and submit appeals to get them approved from insurances.
Proactively work on prior authorizations that are due to be expired.
Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulations.
Ability to work independently with minimal supervision.
Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
Clinical knowledge to be able to answer all clinical questions.
Prepare referral packet for submission to area PRC offices for review and authorization
Prepare and submit private insurance referrals to outside specialist offices
Performs other duties as assigned.
Education Requirements and Qualifications
Required Qualifications:
Education: High School Diploma / Some College Preferred
Certified Medical Assistant
1-3 years of previous pre authorization experience
Knowledge of CPT, HCPCS, ICD-10 codes
Ability to produce detailed work accurately and efficiently
Ability to work with sensitive and confidential information
Strong organizational skills
Customer Service experience
Basic computer skills
Must possess a valid Oklahoma Driver’s License
Preferred Qualifications:
Previous experience working with a Native American entity.
PHYSICAL REQUIREMENTS AND WORKING CONDITIONS
Must be able to sit, stand, stoop, bend or kneel for long periods of time.
Sitting, standing or walking for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling needed; frequent repetitive motions; talking, hearing and visual acuity.
Frequent lifting up to 15 pounds.
Occasional lifting up to 30 pounds.
Native American Preference/EEO/Drug Free/Smoke Free Workplace
Posted Date: 
1 year 3 months ago