Prior Authorization Specialist - Gastroenterology - SRS Scripps Ranch - Per Diem - Variable Shift

Sharp HealthCare•San Diego, CA

1d•$28 - $37

About The Position

This position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, and coordinating patient appointments/orders as it pertains to insurance coverage.

Requirements

H.S. Diploma or Equivalent
1 Year medical assistant experience in related clinical area.
AHA Basic Life Support for Healthcare Professional (AHA BLS Healthcare) - American Heart Association -REQUIRED

Nice To Haves

Certified Medical Assistant (CMA) - California Certifying Board for Medical Assistants -PREFERRED

Responsibilities

Maintain excellent customer service for all customer interactions from patients, medical providers, insurance companies and pharmacies requesting prior authorizations.
Collaborate with ancillary and operational departments to research and resolve customer issues while continuously improving the customer service process.
Work closely with medical staff in obtaining information, resolving issues and ensuring expedient patient flow and customer satisfaction.
Greet patients, pharmaceutical and insurance representatives in a positive and helpful manner. Work with them to obtain information necessary for medication coverage.
Communicate clearly in person and on the phone to establish/maintain cooperative relationships with patients, families, physicians, staff, and management.
Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
Request, follow up and secure prior-authorizations prior to services being performed.
Provide necessary forms to patients for completion and signature. Review all forms for completeness and accuracy.
Verify patient’s pharmacy insurance eligibility.
Effectively utilize the EMR, as well as online authorization sites for medication programs, i.e. CoverMyMeds.
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
Communicate any insurance changes or trends among team.
Maintain a level of productivity suitable for the department.
Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
Offer alternative options to patient to enhance access, system wide.
Knowledgeable of and utilizes scheduling downtime procedure.
Follow guidelines for all calls received and escalates to specified clinical level according to guidelines.
Organize and complete daily requirements and responsibilities.
Troubleshoot and resolve problem calls.
Follow policy and procedure for entering clinical information and utilization of clinical applications.
Completes work within assigned hours.
Able to respond to changing circumstances and prioritize patient needs.
Responds to urgent and emergent situations in a calm and capable manner.
Utilizes good judgment and problem-solving ability.
Demonstrates knowledge of equipment and Information Systems applications.
Able to activate emergency procedure per protocol - code, fire, etc.
Document patient care events in a thorough and accurate manner.
Manage and completes AEHR tasks per prescribed timeframes.
Support and knowledge of new applications and policies: AEHR, Abbreviations, etc.
Demonstrate typing skills proficiency by using a keyboard, required to type proficiently and accurately; Have the ability to type a minimum of 30 words per minute with 0-2 errors; Have the ability to proof work.
Knowledge of technical applications for insurance, utilization review, scheduling requirements, and front/back office responsibilities.
Update patient demographics, insurance, and pharmacy per guidelines.
Able to operate department equipment, including phone system and specified computer applications.