Prior Authorization Specialist

Location: 
Southwest Spine & Pain/ Vista Healthcare
2891 E. Mall Drive
Saint George, UT 84790
Job Description: 

 

 

Southwest Spine and Pain is looking for an Pre-Authorization Specialist for our Admisistrative Offices in St. George, Utah. 

Southwest Spine and Pain continually strives to be one of the best places for patients to receive care and employees to work! If you are ready to start your career as a valued team member with Southwest Spine and Pain then we are interested in talking to you about our current opportunities! 

What You Need to Be Successful: 

Oversee the process of incoming patient orders and obtain information necessary to complete the pre-authorization and scheduling of an order. This process includes collecting all the necessary documentation, contacting the referring physician or their office for additional information or to ask questions regarding the order. Once the information is assembled, determine whether the order is likely to be approved and is ready to be moved on to pre-authorization stage. 

 Essential Functions/Responsibilities:  

  1. Answer calls from patients and physician offices using exemplary customer service skills. 

  1. Accurately enter required information, non-clinical and clinical, into computer database. 

  1. Review clinical data matching it against specified medical criteria and follow established procedures for authorizing request for further review.  

  1. Review incoming orders for completeness to determine if procedure ordered will be covered by insurance (in some cases, pre-certification is not warranted).  

  1. Complete follow-up with physicians for orders still waiting for documentation.  

  1. Contact physicians’ offices to obtain missing documentation to complete orders. 

  1. Works with patients’ insurance companies to pre-certify/authorize procedures as ordered by the referring physician. 

  1. Contact ordering physician with update if procedure is denied and assist with scheduling peer to peer reviews, if needed. 

  1. Once order is complete, contact patient to confirm receipt of order and inform patient he/she will receive a scheduling call once insurance has been approved.  

  1. Monitor pre-certification status to ensure timely processing and completion. 

  1. Log order into the appropriate authorization spreadsheet and schedule procedure once approved.  

  1. Maintain patient confidentiality as defined by state, federal and company regulations. 

  1.  Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families, and physicians. 

  1. Actively support departmental and corporate strategic plans and ensure successful implementation. 

  1. Maintain cooperative working relationships with all clinics and providers. 

Qualifications: 

  1. Six months previous experience in medical prior authorization.   Will train if it is the right person

  1. Knowledge of CPT and ICD-10 codes. 

  1. Familiarity with medical terminology. 

  1. High School Education or GED. 

  1. Ability to interact with patients, insurers and office team members in a responsible, professional and ethical manner. 

  1. Must be able to function effectively in a team-oriented environment. 

  1. Must be able to work independently with limited direction. 

  1. Must be reliable and demonstrate sound judgment and initiative. 

  1. Able to work in a high volume/fast-paced environment. 

Benefits:  

  • Full-time position with Utah’s leading pain management group 

  • Health, Dental & Vision insurance 

  • Life and Disability insurance 

  • Health Savings Account  

  • Paid time off  

  • Paid holidays 

  • 401K 

  • Tuition Reimbursement

  • Employees Asistance Program
     

Job Type: Full-time 

Southwest Spine and Pain is an equal opportunity employer, values the diversity of our workforce and the knowledge of our people. Southwest Spine and Pain will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. 

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