Prior Authorization Specialist - Onsite

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Refuah Health is a federally qualified health center offering comprehensive care in Rockland and Sullivan Counties. We are over one hundred healthcare professionals strong with three decades’ experience providing unparalleled patient care. As an FQHC, we specialize in accessible and affordable care for low income and high-risk residents. We believe in the power of people to create great care and we are inviting the best to build their career with us!

Why Refuah?

• Join a collegial team of coworkers.
• Five modern state of the art facilities.
• Flexible schedules for maximum work-life balance.
• No Prior Authorization experience required. Full training provided.

The Prior Authorization Specialist is responsible for obtaining pre-certifications and authorizations for Refuah patients. They take ownership and serve as the last line of defense against errors.

Duties and responsibilities:

1. Contact insurance companies to verify benefits eligibility
2. Collaborate with Refuah providers to resolve and appeal denied authorizations
3. Ensure all services have prior authorizations. Utilize EMR system checking encounters when necessary and assign to the appropriate provider.
4. Maintain knowledge of Medicaid and third party insurance requirements
5. Verify insurance for in-network or out-of-network benefits
6. Pre-certify services including surgery, office visits, diagnostic testing or any procedure that requires pre-certification
7. Review Pediatric referrals from previous day and help schedule appointments
8. Maintain strict patient confidentiality
9. Maintain authorization records documentation
10. Complies with applicable policies and procedures and supports the Compliance Program
11. Contributes to organizational operations by performing other duties as may be required

Job Requirements:

• High School Diploma

• Knowledge of the health care field with regards to insurance carrier regulations

• Prior experience as a Medical Assistant

• Willingness and ability to quickly learn new software systems and workflows

• Comfort with, and reliability in, performing repetitive or detail‑oriented (tedious) tasks accurately and efficiently.

• Good interpersonal and communication skills

• Ability to project a pleasant and professional image

• Ability to effectively manage conflicts and resolve problems

Working Conditions and Physical Efforts:

• Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full motion of the lower extremities and back muscles.

• Reaching. Extending hand(s) and arm(s) in any direction.

• Standing. Particularly for sustained periods of time.

• Walking. Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.

• Pushing. Using upper extremities to press against something with steady force to thrust forward, downward or outward.

• Pulling. Using upper extremities to exert force to draw, haul or tug objects in a sustained motion.

• Talking. Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

• Hearing. Perceiving the nature of sounds at normal speaking levels with or without correction. Ability to receive detailed information through oral communication, and to make out distinctions in sound.

• Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers.