Prior Authorization Specialist

Position is required to work on-site at Lacks Cancer Center in Grand Rapids, Michigan. This is not a remote position.

Responsible for all aspects of authorizations/pre-certification, or referral processes. Verifies insurance eligibility and contacts the payer to initiate pre-certification by providing supporting medical documentation, follow ups with insurance on outcome of determination for all medication, procedures, and services in attempt to obtain a successful authorization. Determines out of pockets costs for patients prior to treatment start and meet with patients to discuss and share findings, so patient is aware of financial responsibility. Assists in maintaining charge review and claim edit registration work queues and identifying trends to optimize workflows/education needed.

Education
Minimum: High school diploma or equivalent required
Preferred: Degree preferred

Related Experience
Minimum: 1-3 years of experience with insurance referrals, prior authorization or other equivalent knowledge or professional revenue cycle.
Preferred: 3-5 years of experience with insurance referrals, prior authorization or other equivalent knowledge or professional revenue cycle, within an oncology setting.

Preferred: Prior Pharmacy background. Familiar with drug names and coding.

Other Knowledge, Skills and Abilities
▪ Knowledge of medical terminology and procedures at the level needed to perform responsibilities.
▪ Proficient knowledge of major health plans and insurance processes.
▪ Excellent communication skills in both written and verbal forms, including proper phone etiquette, including ability to effectively explain relevant insurance information to patients and providers as well as communicate with insurance plans and internal customers. Ability to read, understand and responds to detailed written and oral instructions.
▪ Ability to work independently and collaboratively in a team-oriented environment; displays profession and friendly demeanor. Proficient knowledge of major health plans and insurance processes.

Computer Competency
Familiarity with standard desktop and Windows based computer system, including email, e-learning, intranet, and computer navigation. Experience working in electronic medical records, preferably EPIC. Ability to use other software required to perform essential functions.

Physical/Mental
Sitting for extended periods of time. Extensive computer work. Frequent standing, walking. Occasional bending stooping, twisting. Ability to hear speech, speak, use near-far vision and fine motor skills. Ability to perform continuously detailed tasks with frequent interruptions and work prioritization.

What Perks and Benefits Can You Look Forward to?

• Day-1 Benefits. Low cost benefits, including medical, dental, vision, 403B retirement and more.
• Paid holidays and generous Paid Time Off (PTO)
  • Up to 18 days of PTO your first year!
• Day Shift Monday – Friday. No Holidays or Weekends
• Tuition reimbursement
• Career Development Services
• Competency based increases.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.