Prior Authorization Specialist

Pacific Neuropsychiatric Specialists Inc

Prior Authorization Specialist

Irvine, CA
Full Time
Paid
  • Responsibilities

    Benefits:

    401(k) matching

    Dental insurance

    Health insurance

    Paid time off

    Vision insurance

    Job Summary:

    We are seeking a motivated and like-minded Health Information Specialist. This is a full-time, in-office position. The Health Information Specialist will manage and maintain the accuracy, security, and privacy of electronic, and paper-based, medical records, manage data quality, and ensure compliance with legal and industry standards. This person will also be responsible for helping with our prior authorizations department by discussing medications, insurance, and prior authorization documents with patients, getting prior authorization approval from insurance companies, filing appeals, and ensuring completeness and accuracy on all prior authorizations.

    Key Responsibilities:

    Submitting requests to insurance companies, gathering necessary documents, completing forms and following up on the status of the requests.

    Provide updates on the authorization, review requests for completeness and ensure all supporting documents are submitted to expedite approvals.

    Receive requests for prior authorizations and ensure that they are properly and closely monitored within company-set standards.

    Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.

    Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is completed.

    Collaborate with other departments to assist in obtaining prior authorizations/appeals.

    Document all interactions with insurance companies within the EMR system.

    Proactively work on prior authorizations that are due to expire.

    Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.

    Required Skills and Qualifications:

    Prior Authorization experience is required

    Experienced with knowing how to submit requests to insurance companies and follow up

    very familiar with the insurance plans - HMO and PPO

    Previous experience working in a medical/psychiatric facility

    Excellent communication skills, both written and oral.

    Proficient telephone and computer skills.

    Must be able to prioritize multiple tasks at once, and deal with high stress levels in an environment of changing priorities.

    Compensation and Benefits:

    PNS offers a competitive compensation package including; medical, dental, and paid time off for full time employees.

    Hourly rate based on skill, experience and tenure of your profession.