Premier Medical Resources
Pre-Authorization Specialist (Clinic)
Premier Medical Resources, Houston, Texas, United States, 77246
Revenue Cycle Management is looking for a Pre‑Authorization Specialist to join our team.
Overview The Pre‑Authorization Specialist is primarily responsible for oversight in obtaining the required pre‑certifications, pre‑authorizations, and referrals for all services accurately and timely. Under the direction of the Revenue Cycle Manager, the employee will ensure that the processes within the department are functioning appropriately. The position offers a hybrid opportunity following 30–90 days of in‑person training.
Essential Functions
Prioritize incoming authorization requests according to urgency.
Generate, verify, and oversee the complete procedure authorization/referral process.
Manage and resolve day‑to‑day issues pertaining to pre‑authorization, as needed.
Monitor provider network status and notify appropriate individuals of non‑network status providers.
Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases.
Notify appropriate departments for approvals and denials.
Initiate and assist with appeals for denied authorizations.
Notify and coordinate P2P (Peer to Peer) requests with the appropriate department.
Confirm accuracy of CPT and ICD‑10 diagnoses in the procedure order.
Contact patients as needed to discuss authorization status.
Maintain, monitor, and update payer medical policy guidelines to manage authorization requirements.
Request, review, and submit necessary patient documentation as needed.
Assist with patient scheduling and inquiries, as necessary.
Apply ICD 10, CPT, modifiers and/or other codes according to coding guidelines.
Communicate with provider and/or all appropriate parties regarding missing information such as CPT, diagnosis codes, documents, clinical reports, etc. to ensure proper authorization processing.
Communicate with other departments regarding changes and/or updates with patient accounts and status.
Manage the status of accounts and identify inconsistencies.
Respond to billing inquiries.
Communicate company goals, expectations, updates, and/or deadlines timely.
Make recommendations on workflow improvement as needed.
Report statistics as required.
Knowledge, Skills, and Abilities
Knowledge of in‑ and out‑of‑network insurances, insurance verification, patient responsibility, and the process for prior authorization.
Familiarity with ICD‑10 and CPT codes and procedures.
Ability to review and understand patient medical documentation.
Ability to independently identify and understand medical necessity requirements.
Task‑oriented and organizational skills; ability to complete tasks timely.
Detail‑oriented focus; being careful about detail and thorough in completing work tasks.
Ability to work independently and as a team.
Ability to adapt with flexibility.
Effective communication skills (written/verbal).
Uses downtime efficiently; is aware of team members workload.
Education and Experience
High school diploma or GED.
Two (2) years of medical office or facility setting experience.
Benefits
3 Medical Plans
2 Dental Plans
2 Vision Plans
Employee Assistant Program
Short‑ and Long‑Term Disability Insurance
Accidental Death & Dismemberment Plan
401(k) with a 2‑year vesting
PTO + Holidays
Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do.
www.pmr-healthcare.com
Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data. Employment for this position is contingent upon the successful completion of a background check and drug screening.
#J-18808-Ljbffr
Overview The Pre‑Authorization Specialist is primarily responsible for oversight in obtaining the required pre‑certifications, pre‑authorizations, and referrals for all services accurately and timely. Under the direction of the Revenue Cycle Manager, the employee will ensure that the processes within the department are functioning appropriately. The position offers a hybrid opportunity following 30–90 days of in‑person training.
Essential Functions
Prioritize incoming authorization requests according to urgency.
Generate, verify, and oversee the complete procedure authorization/referral process.
Manage and resolve day‑to‑day issues pertaining to pre‑authorization, as needed.
Monitor provider network status and notify appropriate individuals of non‑network status providers.
Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases.
Notify appropriate departments for approvals and denials.
Initiate and assist with appeals for denied authorizations.
Notify and coordinate P2P (Peer to Peer) requests with the appropriate department.
Confirm accuracy of CPT and ICD‑10 diagnoses in the procedure order.
Contact patients as needed to discuss authorization status.
Maintain, monitor, and update payer medical policy guidelines to manage authorization requirements.
Request, review, and submit necessary patient documentation as needed.
Assist with patient scheduling and inquiries, as necessary.
Apply ICD 10, CPT, modifiers and/or other codes according to coding guidelines.
Communicate with provider and/or all appropriate parties regarding missing information such as CPT, diagnosis codes, documents, clinical reports, etc. to ensure proper authorization processing.
Communicate with other departments regarding changes and/or updates with patient accounts and status.
Manage the status of accounts and identify inconsistencies.
Respond to billing inquiries.
Communicate company goals, expectations, updates, and/or deadlines timely.
Make recommendations on workflow improvement as needed.
Report statistics as required.
Knowledge, Skills, and Abilities
Knowledge of in‑ and out‑of‑network insurances, insurance verification, patient responsibility, and the process for prior authorization.
Familiarity with ICD‑10 and CPT codes and procedures.
Ability to review and understand patient medical documentation.
Ability to independently identify and understand medical necessity requirements.
Task‑oriented and organizational skills; ability to complete tasks timely.
Detail‑oriented focus; being careful about detail and thorough in completing work tasks.
Ability to work independently and as a team.
Ability to adapt with flexibility.
Effective communication skills (written/verbal).
Uses downtime efficiently; is aware of team members workload.
Education and Experience
High school diploma or GED.
Two (2) years of medical office or facility setting experience.
Benefits
3 Medical Plans
2 Dental Plans
2 Vision Plans
Employee Assistant Program
Short‑ and Long‑Term Disability Insurance
Accidental Death & Dismemberment Plan
401(k) with a 2‑year vesting
PTO + Holidays
Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do.
www.pmr-healthcare.com
Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data. Employment for this position is contingent upon the successful completion of a background check and drug screening.
#J-18808-Ljbffr