Job Description
The Prior Authorization Specialist (Financial Clearance I) at our healthcare client will ensure all required pre-certifications and prior authorizations are obtained for scheduled outpatient services prior to the date of service, in accordance with payer and hospital requirements.
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Required Skills & Experience
- High School Diploma or GED Equivalent
- 2+ years of Prior Authorization Verification Experience
- 2+ years of experience in pre-certification initiation in a healthcare/ health office setting
- Prior insurance experience
- Hands-on experience with insurance portals, including:
• Availity, Carelon, Telligent (HMO referrals and authorizations)
- Demonstrates knowledge of Utilization Management Process
- Medicare/Medicaid experience and knowledge
- Clinical knowledge and understanding of medical services
- Epic experience (ask what tools they used)
- Experience supporting HMO and PPO plans
- Tech Savvy - Proficient in Microsoft Office (Teams specifically)
- Excellent communication and verbal skills
- Eagerness to learn and grow within a company, likes overtime, hardworking
Nice to Have Skills & Experience
- Bachelor's degree
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.