Clinical Prior Authorization Specialist

ID Care is seeking a Clinical Prior Authorization Specialist. If interested in the position please read the job description below and apply. If selected for the position, the candidate would have to come in to the office for a couple of weeks of training then they could work remote.

Department: Clinical

Immediate Supervisor Title: Nurse Manager and/or Sr. Director Clinical Services

Job Supervisory Responsibilities: None

General Summary: A nonexempt position responsible for performing all aspects of the prior authorization process supporting the ID Care clinical staff.

Essential Job Responsibilities:

• Obtain orders and gather clinical and insurance information related to the authorization from providers, clinical staff and/or patient chart.
• Contact and work with insurance companies, including Medicare, to obtain benefit information.
• Obtain health insurance authorization for medications and diagnostic imaging.
• Provide information to providers, nurses and patients regarding coverage and authorization when applicable.
• Update EMR to communicate continuing and final information regarding the authorization process.
• Maintain knowledge of benefits, networks, and CMS regulations to better inform and educate nurses, patients, and providers.
• Answer questions related to insurance deductibles and co-pays, mail order, and assistance eligibility while maintaining productivity and HIPAA standards.
• Identify, review, and provide appropriate and accurate ICD/CPT codes submitted for authorization request.
• Assist with research and call backs regarding escalating issues and denials. Obtain Letter of Medical Necessity when applicable.
• Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
• Maintain current knowledge of insurance (including CMS) regulations, ICD-10 coding, guidelines, procedures.
• Other duties as assigned.

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, scanners, telephone, etc.

Work Environment: Position could be in office or remote home office environment. Office environment is well lit with adequate heat and ventilation.

Education and Experience:

• High school diploma or general equivalency diploma (GED)
• Medical assistant diploma from an accredited vocational institution, or a community college course in medical assisting.
• At least one year with current prior authorization experience and clinical experience in a medical office environment. One or more years’ experience in customer service.
• The medical assistant must maintain current certification from the Certifying Board of the American Association of Medical Assistants (AAMA), the National Center for Competency Testing (NCCT). the American Medical Certification Association (AMCA), the National Association for Health Professionals (NAHP), the National Certification Medical Association (NCMA), or registration from the American Medical Technologies (AMT).
• Must possess a current CPR certification and current health records with the appropriate immunizations to work in the health care field (refer to ID Care Employee Health Policy).

Performance Requirements:

Knowledge:

• Knowledge of health care field and medical office protocols/procedures
• Knowledge of specific assisting tasks related to medical practice.
• Knowledge of ICD/CPT codes
• Knowledge of HIPAA and OSHA regulations

Skills:

• Skill in tact and diplomacy in interpersonal interactions
• Skill in understanding patient education needs by effectively sharing information with patients.

Abilities:

• Ability to project a pleasant and professional image.
• Ability to plan, prioritize, and complete delegated tasks.
• Ability to demonstrate compassion and caring in dealing with others.

Mental and Physical Requirements: Requires sitting and standing associated with normal office environment. Involves looking at a computer monitor for up to 8 hours per day