Job Description

Job Description

Job Description

Black River Health is seeking a highly motivated individual to fill the full-time Prior-Authorization Specialist position. The Prior-Authorization Specialist works with various providers, departments, and insurance companies to facilitate prior-authorization and insurance benefit processes. This position is primarily located at Black River Health’s 8th Street location.

This position is:

• Full-time, 80-hour per pay period, Monday – Friday, benefited

Essential Duties:

• Reviews incoming provider orders for accuracy and completeness.
• Verifies insurance carrier information through online insurance portals, referring provider’s office, contacting patients, phone calls to payers, etc.
• Gathers and reviews supporting documentation needed for the prior authorization process - contacts provider office to obtain missing information.
• Processes referrals according to insurance carrier requirements (submitting medical records, verbally relaying information, completing online and/or phone prior-authorization).
• Collaborates with other departments and providers to assist in obtaining prior authorization, keeping departments apprised of authorization status.
• Maintains accurate records of all prior authorization requests, including documenting approvals and denials.

Educational Qualifications:

• High School Diploma or General Education Degree (GED)
• Two years of post-high school education with a concentration in accounting or business preferred
• Thorough knowledge of medical insurance coverage requirements and terminology
• Thorough knowledge of medical terminology and anatomy and physiology
• Proficiently uses computer, typewriter, and calculator
• Excellent oral and written communication skills
• Excellent interpersonal and customer service skills required
• Works well independently as well as in a team environment

Make Black River Health your home, we make transitions seamless. You will also appreciate excellent benefits, a positive and pleasant healthcare environment that values teamwork, and a passionate focus on patient care. Now is your chance to join this new and exciting opening at Black River Health.

"Black River Health, Inc. is an equal employment opportunity employer functioning under an Affirmative Action Plan."

Job Tags

Similar Jobs