Prior Authorization Specialist
Principal Accountabilities and Essential Duties for Prior Authorization Specialist position
Promotes customer service and satisfaction through competent professional practice and focus on patient needs and expectations.
- Effectively facilitates the coordination of the continuum of patient care in a timely, caring manner, including but not limited to, prior authorizations, verification of patient’s insurance coverage, and coordination of appointments.
- Promotes a positive image through an efficient and cooperative approach to all tasks.
- Presents a professional approach and appearance, a friendly smile and pleasant tone of voice.
- Maintains a calm, caring, and re-assuring demeanor
- Operates as an active part of the team and uses constructive problem-solving
- Maintains confidentiality and refrains from criticism of co-workers, clinics, hospital, guests, and patients.
- Assists the providers and nurses with patient referrals
Functions as a focal communication source.
- Greets patients in a friendly, courteous and professional manner
- Communicates patient care information to appropriate parties in a timely manner
- Maintains necessary forms
- Coordinates and arranges patient referrals and documents all information.
- Acts as a liaison with all insurance personnel in obtaining referral authorizations.
- Acts as a communication link between the physician, nurse, and office manager.
Maintains medical record information and associated confidentiality.
- Serves as a resource to new and existing staff
- Remains flexible and adaptable to changing priorities and performs other duties as assigned
- Coordinates and documents the release of a patient’s medical records to other entities.
- Know how to use MS Word and ability to compose letters
Participates as a member of multidisciplinary teams to coordinate care and ensure continuous improvement in quality of services.
- Attends staff meetings and participates in inter and intra-clinic work teams
- Attends all required in-service and continuing education
- Cross trained to work in a role as a receptionist.
Must have a high school diploma or equivalent.
Preferred knowledge of how health insurance works and terminology.
An annual influenza vaccination is required.
Lake Regional Health System has a competitive benefit and compensation package.
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