Pre-Authorization Specialist

The Pre-Authorization Specialist will assure authorization is obtained for all procedures, diagnostic testing and medications prior to services being rendered. They will work closely with medical staff, clinical staff, Referring Clinics, Central Scheduling and Registration departments. They will be responsible for communication with insurance carriers and or providers for purposes of obtaining approval for services requiring pre-certification and/or prior approval for treatment at Cancer Partners of Nebraska by using web-based tools and other electronic means where possible or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. They will answer high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the Front Desk and Nurses. Essential Duties and Responsibilities: Obtains accurate insurance information, conducts insurance verification via eligibility RTE software or making calls to insurance companies to acquire benefit information and communicates with patient and/or CPN team members regarding any changes or limitations within the policy Secures prior authorization from payers for assigned population. Maintains accurate information in both Electronic Medical Record and Practice Management System of the authorized services. Demonstrates comfort in navigating all payer portals to submit timely auth, working a minimum of 7-14 days in advance of services rendered. Can capably and promptly provide documentation as requested to assist processors in decision making. Communicates confidently with Nurses on the status of the requests and all updates as they impact patient care. Basic understanding of coding: ICD 10's, CPT, HCPCS to communicate medical necessity of the services being ordered. Maximizes utilization of systems provided to assist with the workflow and can utilize the phone, faxes and other communication methods with insurance carriers and/or providers. Demonstrates high level of attention to detail to ensure accuracy in all daily tasks or special projects as assigned. Answers telephone calls in a timely and professional manner. Other duties as assigned. Education and Training: High School Education Medical office/Coding/Insurance or Case Management training or equivalent experience preferred Clinical/nursing education or equivalent experience preferred Experience: Minimum of two years' experience working in a medical office with billing and/or prior authorization, or an equivalent combination of education and/or experience Knowledge, Skills and Abilities Communication - communicates clearly and concisely, both verbally and in writing, use active listening skills, ability to handle a large volume of incoming and outgoing calls Customer oriented - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding customer/provider and referring facilities expectations. Interpersonal skills - ability to work effectively with other employees, patients and external parties. Must be able to work independently as well in a team environment. Computer skills - demonstrates proficiency in PC applications as required. must be able to multi-task Working Conditions: Requires sitting and standing associated with normal office environment Work load: consistent with unscheduled calls and requests to coordinate with co-workers Requires close visual acuity including viewing computer terminal. Extensive reading and reviewing of paperwork Requires spending large amounts of time talking on the telephone Must be able to receive and interpret oral communications accurately to draw valid conclusion regarding insurance coverage and patient financial situations