Prior Authorization Assistant

Duration: 3 to 6 months

Medicaid/Medicare background preferred but not required.

Job Description

Nature of Work:

This position provides assistance to the Prior Authorization Department. This position reports to the Prior Authorization Manager.

Duties and Responsibilities:

• Duties listed below may vary in terms of importance and other duties may be added or eliminated as this position develops.

• Essential Duties and Responsibilities:

• Process and documents all incoming inpatient and outpatient prior authorization (PA) requests as outlined by Client policies and procedures.

• Contacts providers via phone or fax to request additional information or clarification as needed per established process.

• Communicates effectively with customers/providers (both internally and externally) regarding the status of PA requests.

• Enters PA requests into the prior authorization database , prepares documentation, and tasks to the appropriate staff member for clinical review.

• Completes special projects as requested.

Marginal Functions:

Required Qualifications:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• A combination of education, training and experience which provides the necessary knowledge, skills, and abilities as listed below will be considered:

• Ability to communicate effectively both verbally and in writing.

• Knowledge of general business practices

• Detail oriented and organized work ethic.

• Ability to work independently as well as in a team environment.

• Ability to use a personal computer and Microsoft Office software applications, including Word and Excel.

• Knowledge of appropriate telephone etiquette and general business practices

Desirable Qualifications:

• Previous experience in a clinical environment.

• Previous experience working in managed health care setting or insurance environment.

• Knowledge of Medical Terminology.

• Knowledge of additional Microsoft Office software such as PowerPoint.

Physical Demands:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• Must be able to communicate with members, providers, and staff in an effective manner via the telephone and in person.

• Must be able to communicate in writing and understand written materials of a complicated manner.

• Must be able to use a computer terminal to input and access information in a timely manner.

• Must be able to work in a fast-paced environment.

• More than 50% of the time, employee will be working at a desk, with a PC terminal.

Work Conditions/Environment:

All your information will be kept confidential according to EEO guidelines.