Legacy Brain & Spine, LLC
Prior Authorization Specialist
Legacy Brain & Spine, LLC, Atlanta, Georgia, United States, 30383
Legacy Brain & Spine, LLC provided pay range
This range is provided by Legacy Brain & Spine, LLC. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $21.00/hr - $26.00/hr
At ELM Management Services, the Prior Authorization Specialist plays a crucial role in ensuring that patients receive the necessary approvals and benefits before their scheduled outpatient services. This position involves close collaboration with physicians and staff to navigate the process of obtaining prior authorization. By securing these authorizations in advance, the specialist helps streamline patients’ experience and ensures that they can receive the care they need without delays. Reporting directly to the ASC Administrator, this role holds significant responsibility in managing the administrative aspects of outpatient care and facilitating smooth interactions between healthcare providers, patients, and insurance providers.
Essential Functions
Maintains responsibility for all outpatient authorization processes
Confirms insurance verification, insurance eligibility, benefits, and network status for all services
Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request
Follows up on delayed or denied authorization requests and escalates for resolution
Acts as a liaison between the payer and clinic schedulers/medical support staff
Maintains confidentiality of patient information, in accordance with company policy and HIPAA regulations
Creates referrals accurately
Creates detailed documentation and maintains/stores the authorization paper/electronic trail
May work to resolve claims denials related to the prior authorization
Demonstrates ability to tactfully handle difficult situations
Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes
Understands the outpatient scheduling process, front-end to back-end
Assists physicians and office staff to expedite scheduling
Answers incoming phone calls and follows through with requests made by patients and staff personnel
Attempts to collect the estimated self-pay balance of all outpatient services/accounts at the earliest possible collection control point
Identifies patients without adequate insurance coverage and makes contact with the patient or guarantor to determine guarantor’s ability to pay non-covered charges, if applicable
Contacts scheduled patients to obtain pre-service information, explain financial policies, estimates, balances, and obtain a promise to pay on or before services are rendered
Documents concise and understandable notes regarding all accounts collection activity, as well as each patient or guarantor interaction
Other Duties and Responsibilities
Maintains quality and safety in accordance with company policy and HIPAA regulations.
Observes work hours and provides proper notice of absences, tardiness, or work schedule changes
Maintains courteous and cooperative working relationships with management, patients, physicians, other professional contacts, and the public
Presents a well-groomed and professional image
Maintains a working knowledge of available information system capabilities and performs all system applications that are required
Consistently demonstrates the ability to organize work, recognizes and establishes appropriate work priorities, and completes work in a productive manner, without creating backlog
Demonstrates a high-level of customer service skills
Maintains proficiency in data entry skills
Demonstrates ability to tactfully handle difficult situations and/or conversations
Provides feedback to management concerning integrity issues
Perform other work-related duties as requested/directed by management
Completes annual mandatory training as required
Knowledge, Skills, and Abilities
Ability to use discretion and work independently under general supervision
Ability to understand and adhere to the Professional Code of Conduct
Qualifications & Requirements
Minimum of one year healthcare experience
Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. Depending on state-specific requirements, this may include drug testing, health screening, CPR/Basic First Aid, and license/credential verifications
Reasonable accommodation may be made to enable individuals with disabilities to perform these essential functions.
Physical Requirements & Working Conditions: These physical demands are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job. Reasonable accommodation can be made to enable people with disabilities; these are made on a case‑by‑case basis. While performing the responsibilities of the role, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Vision abilities required by this job include close vision.
Limitations and Disclaimer: The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. Other duties may be assigned from time to time.
Equal Employment Opportunity Statement ELM is an equal opportunity employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military, and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision.
Seniority level
Entry level
Employment type
Full‑time
Job function
Other
Medical Practices
#J-18808-Ljbffr
Base pay range $21.00/hr - $26.00/hr
At ELM Management Services, the Prior Authorization Specialist plays a crucial role in ensuring that patients receive the necessary approvals and benefits before their scheduled outpatient services. This position involves close collaboration with physicians and staff to navigate the process of obtaining prior authorization. By securing these authorizations in advance, the specialist helps streamline patients’ experience and ensures that they can receive the care they need without delays. Reporting directly to the ASC Administrator, this role holds significant responsibility in managing the administrative aspects of outpatient care and facilitating smooth interactions between healthcare providers, patients, and insurance providers.
Essential Functions
Maintains responsibility for all outpatient authorization processes
Confirms insurance verification, insurance eligibility, benefits, and network status for all services
Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request
Follows up on delayed or denied authorization requests and escalates for resolution
Acts as a liaison between the payer and clinic schedulers/medical support staff
Maintains confidentiality of patient information, in accordance with company policy and HIPAA regulations
Creates referrals accurately
Creates detailed documentation and maintains/stores the authorization paper/electronic trail
May work to resolve claims denials related to the prior authorization
Demonstrates ability to tactfully handle difficult situations
Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes
Understands the outpatient scheduling process, front-end to back-end
Assists physicians and office staff to expedite scheduling
Answers incoming phone calls and follows through with requests made by patients and staff personnel
Attempts to collect the estimated self-pay balance of all outpatient services/accounts at the earliest possible collection control point
Identifies patients without adequate insurance coverage and makes contact with the patient or guarantor to determine guarantor’s ability to pay non-covered charges, if applicable
Contacts scheduled patients to obtain pre-service information, explain financial policies, estimates, balances, and obtain a promise to pay on or before services are rendered
Documents concise and understandable notes regarding all accounts collection activity, as well as each patient or guarantor interaction
Other Duties and Responsibilities
Maintains quality and safety in accordance with company policy and HIPAA regulations.
Observes work hours and provides proper notice of absences, tardiness, or work schedule changes
Maintains courteous and cooperative working relationships with management, patients, physicians, other professional contacts, and the public
Presents a well-groomed and professional image
Maintains a working knowledge of available information system capabilities and performs all system applications that are required
Consistently demonstrates the ability to organize work, recognizes and establishes appropriate work priorities, and completes work in a productive manner, without creating backlog
Demonstrates a high-level of customer service skills
Maintains proficiency in data entry skills
Demonstrates ability to tactfully handle difficult situations and/or conversations
Provides feedback to management concerning integrity issues
Perform other work-related duties as requested/directed by management
Completes annual mandatory training as required
Knowledge, Skills, and Abilities
Ability to use discretion and work independently under general supervision
Ability to understand and adhere to the Professional Code of Conduct
Qualifications & Requirements
Minimum of one year healthcare experience
Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. Depending on state-specific requirements, this may include drug testing, health screening, CPR/Basic First Aid, and license/credential verifications
Reasonable accommodation may be made to enable individuals with disabilities to perform these essential functions.
Physical Requirements & Working Conditions: These physical demands are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job. Reasonable accommodation can be made to enable people with disabilities; these are made on a case‑by‑case basis. While performing the responsibilities of the role, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Vision abilities required by this job include close vision.
Limitations and Disclaimer: The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. Other duties may be assigned from time to time.
Equal Employment Opportunity Statement ELM is an equal opportunity employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military, and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision.
Seniority level
Entry level
Employment type
Full‑time
Job function
Other
Medical Practices
#J-18808-Ljbffr