Prior Authorization Specialist - Gastroenterology - SRS Scripps Ranch - Per Diem - Variable Shift
Company: SHARP HEALTHCARE
Location: San Diego
Posted on: April 24, 2024
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Job Description:
HoursShift Start Time:VariableShift End Time:VariableAdditional
Shift Information:Weekend Requirements:As NeededOn-Call
Required:NoHourly Pay Range (Minimum - Midpoint - Maximum):$23.100
- $28.514 - $34.217 -The stated pay scale reflects the range that
Sharp reasonably expects to pay for this position.--- The actual
pay rate and pay grade for this position will be dependent on a
variety of factors, including an applicant's years of experience,
unique skills and abilities, education, alignment with similar
internal candidates, marketplace factors, other requirements for
the position, and employer business practices. - -
What You Will Do
This position is responsible for obtaining pre-certifications and
pre-authorizations for procedures and medications, scheduling
appointments for outpatient testing with other providers, and
coordinating patient appointments/orders as it pertains to
insurance coverage.
Required Qualifications
Preferred Qualifications
Essential Functions
Maintain excellent customer service for all customer interactions
from patients, medical providers, insurance companies and
pharmacies requesting prior authorizations.
Collaborate with ancillary and operational departments to research
and resolve customer issues while continuously improving the
customer service process.
Work closely with medical staff in obtaining information, resolving
issues and ensuring expedient patient flow and customer
satisfaction.
Greet patients, pharmaceutical and insurance representatives in a
positive and helpful manner. Work with them to obtain information
necessary for medication coverage.
Communicate clearly in person and on the phone to
establish/maintain cooperative relationships with patients,
families, physicians, staff, and management.
Contact insurance carriers to verify patient's insurance
eligibility, benefits and requirements.
Request, track and obtain pre-authorization from insurance carriers
within time allotted for medical and services.
Request, follow up and secure prior-authorizations prior to
services being performed.
Provide necessary forms to patients for completion and signature.
Review all forms for completeness and accuracy.
Verify patient's pharmacy insurance eligibility.
Effectively utilize the EMR, as well as online authorization sites
for medication programs, i.e. CoverMyMeds.
Demonstrate and apply knowledge of medical terminology, high
proficiency of general medical office procedures including HIPAA
regulations.
Communicate any insurance changes or trends among team.
Maintain a level of productivity suitable for the department.
Clearly document all communications and contacts with providers and
personnel in standardized documentation requirements, including
proper format.
Offer alternative options to patient to enhance access, system
wide.
Knowledgeable of and utilizes scheduling downtime procedure.
Follow guidelines for all calls received and escalates to specified
clinical level according to guidelines.
Organize and complete daily requirements and responsibilities.
Troubleshoot and resolve problem calls.
Follow policy and procedure for entering clinical information and
utilization of clinical applications.
Completes work within assigned hours.
Able to respond to changing circumstances and prioritize patient
needs.
Responds to urgent and emergent situations in a calm and capable
manner.
Utilizes good judgment and problem-solving ability.
Demonstrates knowledge of equipment and Information Systems
applications.
Able to activate emergency procedure per protocol - code, fire,
etc.
Document patient care events in a thorough and accurate manner.
Manage and completes AEHR tasks per prescribed timeframes.
Support and knowledge of new applications and policies: AEHR,
Abbreviations, etc.
Demonstrate typing skills proficiency by using a keyboard, required
to type proficiently and accurately; Have the ability to type a
minimum of 30 words per minute with 0-2 errors; Have the ability to
proof work.
Knowledge of technical applications for insurance, utilization
review, scheduling requirements, and front/back office
responsibilities.
Update patient demographics, insurance, and pharmacy per
guidelines.
Able to operate department equipment, including phone system and
specified computer applications.
Sharp HealthCare is an equal opportunity/affirmative action
employer. All qualified applicants will receive consideration for
employment without regard to race, religion, color, national
origin, gender, gender identity, sexual orientation, age, status as
a protected veteran, among other things, or status as a qualified
individual with disability or any other protected class
AHA Basic Life Support for Healthcare Professional (AHA BLS
Healthcare) - American Heart Association; Certified Medical
Assistant (CMA) - California Certifying Board for Medical
Assistants; H.S. Diploma or Equivalent
Keywords: SHARP HEALTHCARE, La Mesa , Prior Authorization Specialist - Gastroenterology - SRS Scripps Ranch - Per Diem - Variable Shift, Other , San Diego, California
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