at CHC-SEK in Fort Scott, Kansas, United States
Job Description
GENERAL DESCRIPTION
The Prior Authorization Specialist I is responsible for diagnostic and procedure orders management, including completing prior authorizations, scheduling appointments, obtaining order results, and submitting results to the ordering provider. The Prior Authorization Specialists I assists patients with applications for programs to support the financial obligations needed to complete screening exams, and scheduling in-house diagnostic exams.
Requirements
ESSENTIAL DUTIES
- Reviews order within the Electronic Health Record System with insurance companies to determine need for prior authorization.
- Processes prior authorizations and sends any supporting documentation to insurance companies to expedite the prior authorization process.
- Schedules diagnostic imaging and procedure appointments appropriate for the patient’s needs, internally or externally.
- Manage correspondence with insurance companies, physicians, specialist and patients, as needed, including documenting in the EHR as appropriate.
- Reviews denials and follows up with the provider to obtain medically necessary information to submit an appeal of the denial.
- Prioritizes orders by level of urgency.
- Requests order results from external facilities and submits the results to the order provider to support continuation of care.
- Assists patients with program applications to finance screening diagnostic imaging exams.
