About this opportunity
Hartford HealthCare lists this Prior Authorizations Specialist - General Surgery opportunity in trumbull, Connecticut. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Prior Authorization SpecialistWork where every moment matters.Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.Hartford HealthCare Medical Group is one of the largest medical practices in New England with multiple locations throughout Connecticut and Rhode Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group enjoys an excellent reputation with patients and the medical community, offering primary care, urgent care and more than 30 different specialties.Job DescriptionUnder the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain insurance prior authorizations for all in office procedures, and any surgical services in a timely manner. Responsible for creating, maintaining and managing resources, including insurance portal access. Must have consistent documentation in EPIC to support the obtained insurance authorization. Will communicate changes in payer and or federal regulatory guidelines to their manager, providers and other clinical departments, as applicable.Monitors and reviews the prior authorization work queue daily to verify accuracy of patient's insurance information and to interpret insurance pre-authorization requirements for scheduled procedures.Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled date of procedure.Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.Immediately communicates to provider when a procedure, or surgery is denied by the insurance company. Assists in setting up peer to peer reviewsCollaborates and communicates with pharmacy regarding preferred drugs on the particular insurance plan and notifies providers of alternativesMaintains log of missed prior authorizations and assists manager with timely retro authorizations or appeals to recoup revenue.Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.When time allows can help out in the office with managing incoming phone calls, baskets and other front desk coverage, answering phones and transcribing orders and referrals.Monitoring referral work queue, registering arriving patients, answering incoming calls, surgical scheduling as well as other assigned duties as needed.QualificationsHigh School Graduate/Diploma preferredAt least one year experience working with insurances and prior authorizations, preferredExperience and knowledge of insurances and prior authorizationsAbility to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companiesMust be self-motivated and have the ability to work independently and within a teamDemonstrates excellent telephone, computer, organization and customer service skills
Worksite address
trumbull, CT, 06611, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.