Prior Authorization Specialist

Position Purpose: This position is responsible for working closely with Patient, Patient Access, Payers, and Providers' office to validate insurance plans, eligibility, and orders to procure required prior authorizations. Organization: This position reports to the Revenue Cycle Manager. Essential Job Functions include the following. Other duties may be assigned.

• Collaborate with insurers to obtain pre-authorizations for condition-specific medications, diagnostic procedures and treatments, and support patients in navigating barriers / coverage and disputes.
• Submit prior authorization requests for medical procedures, diagnostic tests, treatments, and medications as required by insurance providers.
• Gather, review, and submit all necessary clinical documentation to support authorization requests, ensuring accuracy and completeness.
• Communicate with insurance representatives to clarify requirements, resolve authorization denials, and follow up on pending approvals.
• Collaborate with physicians, nurses, and other clinical staff to obtain additional clinical information or documentation required by insurance companies.
• Inform patients about the status of their authorization requests, answer questions regarding coverage, and provide guidance on next steps.
• Maintain accurate and detailed records of all prior authorization requests, outcomes, and patient information in compliance with HIPAA regulations.
• Stay updated on changes in insurance policies, state and federal regulations, and organizational policies affecting prior authorizations and reimbursement.
• Meet quality and productivity standards set by Signature and/or our client.
• Provide excellent customer service in keeping with Signature's legacy both internal and externally.
• Maintain expertise in multiple current client systems.
• Maintain up to date knowledge of revenue cycle management, industry trends perform other duties as necessary.
• Acts as an effective team member.

Required Knowledge & Experience:

• Minimum 2 years of prior authorization experience, insurance coordination, or case management within a physician office, hospital, or insurance plan authorizations unit.
• Understanding of healthcare insurance systems
• Strong written and verbal communication skills with the ability to explain complex medical and insurance information
• Strong attention to detail
• Passion for patient advocacy with a problem-solving mindset, focusing on overcoming challenges to accessing care.
• Ability to work effectively both independently and as part of a multidisciplinary team
• Computer proficiency including Microsoft Office, Word, Excel and Outlook
• Ability to function effectively in a fast-paced environment.
• Personal traits of a high-level commitment, motivation, energy, team orientation, professionalism, trust, personal honesty and integrity, and a demonstration of placing others in a place of high value.

Preferred Knowledge & Experience:

• Preferred experience and understanding of medical terminology
• General knowledge of CPT/HCPCS and ICD-10

General Areas of Accountability: Must conduct business and personal affairs in a manner that is always a credit to the company. Must maintain a good credit rating while employed with the company. The following HIPAA and Privacy items apply to all positions at Signature Performance:

• Follow HIPAA guidelines for protecting the privacy and security of sensitive personal and/or health information.
• Follow Signature expected acceptable use to protect propriety and company owned information.
• Complete annually required Privacy and Security Training

PERFORMANCE MANAGEMENT: All Signature Performance associates are subject to regular performance management to determine if skills and training requirements are suitable for the position. Machines and Equipment: The incumbent must be able to effectively operate the current computer system, telephone system, and other office machines such as copiers and fax machines. SECURITY REQUIREMENTS:

• U.S. Citizenship, naturalized citizenship, or permanent status is required for this position.
• All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Physical Activity: The incumbent must be able to finger, grasp, feel, see, sit, hear, and speak. This position is sedentary in nature with m Apply tot his job Apply To this Job