Patient Prior Authorization Specialist

Responsible for patient prior authorization, patient referrals including scheduling of internal referral and outgoing patient referrals, documentation of status of prior authorizations and referrals, ability to navigate registration, referral entries, auth/cert entries and patient chart workflows in EPIC, ability to update and confirm current patient insurance coverage and day to day monitoring of all EPIC prior authorizations and referrals work queues.

Principal Accountabilities

Standards of Performance: Respect, Integrity, Compassion, Collaboration, Stewardship, Accountability, Quality

Education

High School diploma or equivalent

Licenses and Certification

N/A

Experience and Skills

Technical Experience: 1 to 3 years of office experience required and 1 year EMR experience preferred. Effective and excellent communication skills.

Physical Activities

Intermittent hand manipulation required

Intermittent lifting and carrying of 20 pounds

Role Specific Responsibilities

Monitors EPIC prior authorization and referrals work queues daily

Classified insurance approvals, based on physician orders, in order to expedite claim processing.

Identify and prioritize urgent and emergency prior authorizations and referral consultation requests

Checks chart for relevant referral/prior authorization information and shares with appropriate insurance provider or referring office provider

Call or submit online request to insurance providers for prior authorizations

Communicates details regarding denials and peer-to-peer request for prior authorizations and provider offices

Communicates effectively with patients, provider staff and insurance providers by telephone and Epic Inbasket

Follow through on referrals and prior authorizations to completion/resolution in a timely fashion

Document progress/status of prior authorizations and referrals on the EPIC referral or EPIC auth/cert forms

Follow-up on missing insurance documentation with patients

Schedules internal referrals in EPIC directly onto the provider's schedule.

Validates information for a prior authorization or referral request and follows-up with providers office regarding missing CPT codes or missing chart documentation

Collaborates with staff to identify workflow problems and identify solutions

Consistently looks for ways to streamline the prior authorization and referrals process and improve the patient and staff experience

Leads, tracks, monitors updates in insurance prior authorization criteria and educate provider staff

Compensation (Commensurate with experience): $16.56 - $24.84

To access our Benefits Guide/Plan Information, please click the link below:

http://www.sih.net/careers/benefits