Job Description

Prior Authorizations Specialist- Pain Management

Location Detail: 190 Universal Dr North Haven (10494)
Shift Detail: Monday-Friday 8:00am-4:30pm or 8:30am-5:00pm

Hartford HealthCare Medical Group is one of the largest medical practices in New England with multiple locations throughout Connecticut and Rhode Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician?led medical group enjoys an excellent reputation with patients and the medical community, offering primary care, urgent care and more than 30 different specialties.

Under the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain insurance prior authorizations for all in?office procedures, medications, and any surgical services in a timely manner. Responsible for creating, maintaining and managing resources, including insurance portal access. Must have consistent documentation in EPIC to support the obtained insurance authorization. Will communicate changes in payer and or federal regulatory guidelines to their manager, providers and other clinical departments, as applicable.

• Monitors and reviews the prior authorization work queue daily to verify accuracy of patients insurance information and to interpret insurance pre?authorization requirements for scheduled procedure, surgery and or medication.
• Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled date of procedure.
• Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.
• Immediately communicates to provider when a procedure, medication or surgery is denied by the insurance company. Assists in setting up peer to peer reviews.
• Collaborates and communicates with pharmacy regarding preferred drugs on the particular insurance plan and notifies providers of alternatives.
• Maintains log of missed prior authorizations and assists manager with timely retro authorizations or appeals to recoup revenue.
• Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.
• When time allows can help out in the office with managing incoming phone calls, baskets and other front desk coverage, answering phones and transcribing orders and referrals.
• Monitoring referral work queue, registering arriving patients, answering incoming calls as well as other assigned duties as needed.

Qualifications

• High School Graduate/Diploma preferred
• At least one year experience working with insurances and prior authorizations, preferred
• Experience and knowledge of insurances and prior authorizations
• Ability to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companies
• Must be self?motivated and have the ability to work independently and within a team
• Demonstrates excellent telephone, computer, organization and customer service skills

We take great care of careers. With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment .

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