TEKsystems
Prior Authorization Specialist
TEKsystems, Norfolk, Virginia, United States, 23500
As the *Prior Authorization Specialist** **If youre ready to explore the next step in your career:** **Youll enjoy**Career Opportunities*
Tons of growth opportunities for your career*Standard Hours*
100% in office role. Monday-Friday (8:30am-5:00pm)*Competitive Pay* - $21.00+ an hour*Expedite Interviews*
Access to additional Resumesupport and pre-interview questions* **A day in the role** Review, process, and audit the medical necessity for each patient treatment and documentation of regimen relative to pathway adherence* Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans* Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered drugs* Update coding/payer guidelines for clinical staff* Track pathways and perform various other business office functions on an as needed basis, obtain insurance authorization and pre-certification specifically for services* Research additional or alternative resources for non-covered services to prevent payment denials* Each Clinical Insurance Reviewer works out of a queue in their EMR.* They sort authorizations needed by due date or start date that the provider puts in and works backwards.* They clean up their work que first and then they start doing authorizations.* They need to respond to the clinics - they are sending messages through the EMR so they need to make sure they are responding timely because the clinic/providers cannot provide treatment unless CIR approves.* They are using the insurance carrier portals, navigating pathways, calling into insurance companies and faxing to obtain authorizations for chemotherapy IV and injectable drugs* They will enter authorization info into their EMR which is InoMed (G2) and their practice management system - Athena* **Necessary Skills and Strengths:*Insurance Authorizations | Insurance Verifications | Health Insurance | ICD-10 Codes | CPT Codes | Medical Insurance Knowledge | Medical Billing Knowledge* **Core Experience:** 1+ years of prior authorization experience* Insurance payer knowledge* Payer website knowledge* Medical Billing or AR experience (alternative to authorization experience)* Insurance VerificationsAbout TEKsystems:We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Tons of growth opportunities for your career*Standard Hours*
100% in office role. Monday-Friday (8:30am-5:00pm)*Competitive Pay* - $21.00+ an hour*Expedite Interviews*
Access to additional Resumesupport and pre-interview questions* **A day in the role** Review, process, and audit the medical necessity for each patient treatment and documentation of regimen relative to pathway adherence* Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans* Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered drugs* Update coding/payer guidelines for clinical staff* Track pathways and perform various other business office functions on an as needed basis, obtain insurance authorization and pre-certification specifically for services* Research additional or alternative resources for non-covered services to prevent payment denials* Each Clinical Insurance Reviewer works out of a queue in their EMR.* They sort authorizations needed by due date or start date that the provider puts in and works backwards.* They clean up their work que first and then they start doing authorizations.* They need to respond to the clinics - they are sending messages through the EMR so they need to make sure they are responding timely because the clinic/providers cannot provide treatment unless CIR approves.* They are using the insurance carrier portals, navigating pathways, calling into insurance companies and faxing to obtain authorizations for chemotherapy IV and injectable drugs* They will enter authorization info into their EMR which is InoMed (G2) and their practice management system - Athena* **Necessary Skills and Strengths:*Insurance Authorizations | Insurance Verifications | Health Insurance | ICD-10 Codes | CPT Codes | Medical Insurance Knowledge | Medical Billing Knowledge* **Core Experience:** 1+ years of prior authorization experience* Insurance payer knowledge* Payer website knowledge* Medical Billing or AR experience (alternative to authorization experience)* Insurance VerificationsAbout TEKsystems:We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.