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[Hiring] Prior Authorization Specialist @BMC Company 100 id-10401

Role Description

Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including a broad range of requests for inpatient, outpatient and ancillary services.

Qualifications

  • High school diploma or GED required; Associate’s Degree or higher preferred.
  • 4-5 years of office experience in a high volume data entry office, customer service call center, or healthcare office.
  • Experience using insurance payer websites (e.g., Blue Cross Blue Shield, Medicare).
  • Customer service experience preferred.
  • Experience with insurance verification, prior authorization, pre-certification, and financial clearance process.

Requirements

  • Bilingual preferred.
  • Ability to process a high volume of requests with a 95% or greater accuracy rate.
  • Ability to prioritize workload when processing referrals and authorization requests per guidelines.
  • Effective collaboration skills.
  • Strong oral and written communication skills.
  • Thorough knowledge of financial clearance process is a must.
  • Familiarity with insurances, referral authorizations, and third-party billing procedures.
  • Knowledge of basic medical terminology and ICD-9/CPT coding is helpful.
  • Excellent interpersonal skills to build and maintain strong relationships.
  • Self-directed and highly organized with the ability to multitask.
  • Requires ability to make independent decisions under pressure.
  • Must maintain confidentiality of all personal/health sensitive information.
  • Knowledge of and experience within Epic is preferred.
  • Basic computer proficiency, including Microsoft Suite applications.

Benefits

  • Opportunity to make a difference as part of our mission to provide exceptional and equitable care.
  • Recognized as a top employer and best place to work.
  • Strong sense of teamwork and support for staff.

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