PRACTICE WORKS MD LLC Hiring for Prior Authorization Specialist Job at Sarasota, FL Full Time

POSITION REQUIREMENTS:

1. Verifies insurance coverage and obtains insurance authorizations/referrals/pre-certification as required for all new/established patients.

2. Verifies insurance information every 90 days on all established patients and follows up on referrals/authorizations to assure they are current and active.

3. Pulls daily a list of add on appointments. Verifies insurance if over 90 days and requests referral/authorization when needed.

4. Maintains appropriate knowledge of insurance requirements to include knowledge of which carriers require referrals and/or authorizations and pre-certifications.

5. Has sufficient knowledge of correlation between procedures and payable diagnosis.

6. Communicates with Client, via telephone or Practice Works MD IS, as appropriate, to advise if written referral is required prior to appointment/procedure. Provides information regarding Authorizations Process, schedules and procedures to assure efficient capture of revenue for services rendered.

7. Maintains ongoing communication with Practice Works MD Staff and the RCS responsible for other functions of the Revenue Cycle.

8. Documents all account activity in the applicable Practice Works MD IS, in accordance with Practice Works MD RCS Documentation Standards. Communicates with staff by phone/email with information pertinent to the patient’s financial account.

9. Retrieves and responds to voice mail messages:

a. by 5pm EST of the same day, if received prior to 3pm EST; or

b. by 12N EST of the following day, if received after 3pm EST

10. Identifies appropriate escalation points and works with the Vice President of Operations to resolve issues.

11. Assists with the identification of trends and root cause analysis, relative to authorizations, and communicates with the Vice President of Operations, as appropriate to reduce delays and minimize denials.

12. Maintains a comprehensive understanding of State and Federal Regulatory Requirements, relative to RCM, as well as resources and tools available to gather information for verifying insurance coverage, authorizations/referrals/pre certification.

13. Consistently meets pre-defined productivity metrics and performance standards.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Sarasota, FL 34232: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Insurance verification: 1 year (Required)

Work Location: One location