Medavie Health Services
PURPOSE OF POSITION:
The Prior Authorization Specialist ensures patients receive services and medications that requires pre-authorization from insurance carrier. Communicates with patients by analyzing insurance prior authorization requirements. It is the responsibility of the Prior Authorization Specialist to receive, process and document all requirements, submit the required documentation, and update the Prior Authorization submission documents when necessary.
This position will require 2-4 weeks of on-site training in Liverpool, NY.
EXAMPLES OF DUTIES:
Prioritizes incoming prior-authorization request as outlined in departmental policies, procedures, and workflow guidelines.
Contact's patient's health plans to obtaining plan information, verify active coverage, obtain all plan benefits as well as authorization requirements.
Ability to understand and communicate insurance co-pays, deductibles, co-insurance, and out of pocket expenses for point of service collections.
Communicates efficiently and professionally with patients providing coverage information and payment responsibilities for services.
Submits medical records, and works with the provider on necessary documentation, (if necessary) to obtain benefits and authorization.
Documents, within the EMR system, all required information, including patient financial responsibility.
Ensures insurance carrier documentation requirements are met and Authorization documentation is documented in the patient's medical record.
Documents all information from the authorization forms and ensures that providers are following standard guidelines for adequate reimbursement. It is the responsibility of the Prior Authorization Specialist to communicate with the clinical staff, surgical schedulers, related providers and receptionist on any denials and delays in obtaining authorization as well as communicates patterns of denials that occur or being processed inconsistently.
Manages correspondences with patients, physicians, specialists, and insurance companies.
Manage inbound calls from insurance companies, and patients regarding inquiries about services provided, financial responsibility and insurance coverage.
Ensure appropriate signatures are obtained on necessary forms.
Pre-screen's "to-do" queues working 1 - 3 weeks out, along with obtaining benefits and authorizations for daily add-ons.
Completes insurance eligibility check on all surgeries and procedures scheduled to ensure patient's insurance is active, and authorizations is valid for upcoming visit.
Runs daily reports, capturing missed appointments requiring authorization.
Obtains any/all retro-authorizations in a timely manner, following up daily on any outstanding authorizations.
Works with the offices ensuring all peer-to-peer reviews are scheduled and appeals and denials are handled.
Maintains excellent relationships with the practice sites and communicates any issues when obtaining benefits and authorizations.
Works with the billing supervisors and staff, ensuring benefits and authorization requirements are met, and information relayed according to policy.
Education / Licensure / Experience:
High School Graduate
An Associate Degree is preferred
Minimum of one (1) years of related experience
Prior use of Medent/EMR systems preferred
What We are Offer You
At U.S. Urology Partners, we are guided by four core values. Every associate living the core values makes our company an amazing place to work. Here "Every Family Matters"
Compassion
Make Someone's Day Collaboration
Achieve Possibilities Together Respect
Treat people with dignity Accountability
Do the right thing
Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans, HSA / FSA, 401(k) matching, an Employee Assistance Program (EAP) and more.
About US Urology Partners
U.S. Urology Partners is one of the nation's largest independent providers of urology and related specialty services, including general urology, surgical procedures, advanced cancer treatment, and other ancillary services. Through Central Ohio Urology Group, Associated Medical Professionals of NY, Urology of Indiana, and Florida Urology Center, the U.S. Urology Partners clinical network now consists of more than 50 offices throughout the East Coast and Midwest, including a state-of-the-art, urology-specific ambulatory surgery center that is one of the first in the country to offer robotic surgery. U.S. Urology Partners was formed to support urology practices through an experienced team of healthcare executives and resources, while serving as a platform upon which NMS Capital is building a leading provider of urological services through an acquisition strategy.
Salary Range: Please note that the hourly range for this position will vary based on experience level, education and geographical location. $0.00 - $0.00 / hour
U.S. Urology Partners is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
The Prior Authorization Specialist ensures patients receive services and medications that requires pre-authorization from insurance carrier. Communicates with patients by analyzing insurance prior authorization requirements. It is the responsibility of the Prior Authorization Specialist to receive, process and document all requirements, submit the required documentation, and update the Prior Authorization submission documents when necessary.
This position will require 2-4 weeks of on-site training in Liverpool, NY.
EXAMPLES OF DUTIES:
Prioritizes incoming prior-authorization request as outlined in departmental policies, procedures, and workflow guidelines.
Contact's patient's health plans to obtaining plan information, verify active coverage, obtain all plan benefits as well as authorization requirements.
Ability to understand and communicate insurance co-pays, deductibles, co-insurance, and out of pocket expenses for point of service collections.
Communicates efficiently and professionally with patients providing coverage information and payment responsibilities for services.
Submits medical records, and works with the provider on necessary documentation, (if necessary) to obtain benefits and authorization.
Documents, within the EMR system, all required information, including patient financial responsibility.
Ensures insurance carrier documentation requirements are met and Authorization documentation is documented in the patient's medical record.
Documents all information from the authorization forms and ensures that providers are following standard guidelines for adequate reimbursement. It is the responsibility of the Prior Authorization Specialist to communicate with the clinical staff, surgical schedulers, related providers and receptionist on any denials and delays in obtaining authorization as well as communicates patterns of denials that occur or being processed inconsistently.
Manages correspondences with patients, physicians, specialists, and insurance companies.
Manage inbound calls from insurance companies, and patients regarding inquiries about services provided, financial responsibility and insurance coverage.
Ensure appropriate signatures are obtained on necessary forms.
Pre-screen's "to-do" queues working 1 - 3 weeks out, along with obtaining benefits and authorizations for daily add-ons.
Completes insurance eligibility check on all surgeries and procedures scheduled to ensure patient's insurance is active, and authorizations is valid for upcoming visit.
Runs daily reports, capturing missed appointments requiring authorization.
Obtains any/all retro-authorizations in a timely manner, following up daily on any outstanding authorizations.
Works with the offices ensuring all peer-to-peer reviews are scheduled and appeals and denials are handled.
Maintains excellent relationships with the practice sites and communicates any issues when obtaining benefits and authorizations.
Works with the billing supervisors and staff, ensuring benefits and authorization requirements are met, and information relayed according to policy.
Education / Licensure / Experience:
High School Graduate
An Associate Degree is preferred
Minimum of one (1) years of related experience
Prior use of Medent/EMR systems preferred
What We are Offer You
At U.S. Urology Partners, we are guided by four core values. Every associate living the core values makes our company an amazing place to work. Here "Every Family Matters"
Compassion
Make Someone's Day Collaboration
Achieve Possibilities Together Respect
Treat people with dignity Accountability
Do the right thing
Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans, HSA / FSA, 401(k) matching, an Employee Assistance Program (EAP) and more.
About US Urology Partners
U.S. Urology Partners is one of the nation's largest independent providers of urology and related specialty services, including general urology, surgical procedures, advanced cancer treatment, and other ancillary services. Through Central Ohio Urology Group, Associated Medical Professionals of NY, Urology of Indiana, and Florida Urology Center, the U.S. Urology Partners clinical network now consists of more than 50 offices throughout the East Coast and Midwest, including a state-of-the-art, urology-specific ambulatory surgery center that is one of the first in the country to offer robotic surgery. U.S. Urology Partners was formed to support urology practices through an experienced team of healthcare executives and resources, while serving as a platform upon which NMS Capital is building a leading provider of urological services through an acquisition strategy.
Salary Range: Please note that the hourly range for this position will vary based on experience level, education and geographical location. $0.00 - $0.00 / hour
U.S. Urology Partners is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.