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Prior-Authorization Specialist

Location : Valencia, CA
Job Type : Temp/Contract
Hours : Full Time
Travel : No
Relocation : No

Job Description :
The Prior Authorization Specialist is responsible for performing the initial benefit verification and pre-authorization functions with insurance carriers, within an established time frame, for new pre-surgical cases submitted to the Reimbursement Services Department. The Prior Authorization Specialist is responsible for providing competitive levels of support to the internal team, Health Care Professional offices, and sales representatives. They are also responsible for answering incoming calls received through the Reimbursement Services Department ACD line.

Key Responsibilities:
• Answers incoming calls received through the toll free Reimbursement Services ACD and provide appropriate call/case handling.
• Performs initial benefit verification and pre-surgical authorization for new pre-surgical cases by working closely with all payers
• Documents case status, actions, and outcome in the Reimbursement Services contact management database
• Communicates with HCP offices and sales representatives in regards to missing case information and upon approvals, as appropriate
• Works closely with the designated Reimbursement Specialists as it relates to benefit verification information received, questions about pre-authorization, payer issues, and case volume
• Responsible for notifying the appropriate internal departments based on receipt of information that department needs to be aware of including complaint handling/ adverse event notifications
• Utilizes customer service skills in engaging with customers, communications with Sales representatives, and working in teams in a call center environment to expedite processing of cases
• Responsible for working with Reimbursement Services Manager to develop and generate key reporting metrics and for making Intake process improvement recommendations



Required Qualifications :
• MUST HAVE Previous experience in Insurance Pre-Authorization (not collections), or Medical device industry.
• Must be able to understand the complexities of the Insurance Reimbursement work flow and related processes.
• Must have basic understanding of Medicare, Medicaid, Private Payer, and Workers compensation coding, coverage, and payment as it relates to medical procedures, services, and devices
• Must possess strong computer skills including Microsoft Word and Excel. Experience in other applications such as PowerPoint and Publisher is a plus
• Must have exceptional organizational skills and a keen attention to detail
• Must demonstrate ability to effectively build relationships and communicate with both internal and external customers
• Must be able to accurately document and verbalize issues and have the ability to work with in a team environment and across departments
• Must be able to work in an environment where meeting and executing on timelines is essential. MUST be a team player
• Must be able to work in a fast pace environment in which information is constantly changing; must be able to embrace changes
• College undergraduate degree strongly preferred. Some college coursework required
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