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Job Summary:
The Associate Prior Authorization Specialist assists with Utilization Management processes.
Essential Functions:
- Convert information obtained from providers/members, (received via fax, phone or mail) into electronic records
- Facilitate/assist the authorization of benefits for out-of-network providers including completion of appropriate forms that are distributed to physicians’ offices, provider relations and the generation of approval letters
- Assist with authorizations as directed by desk references
- Complete necessary contact with provider/member to verify newborn information
- Input required data into system for newborns
- Provide authorization number to provider or facility
- Assist PCC team support as directed
- Maintain knowledge and understanding of all processes and procedures for assigned market on faxes and phones
- Adhere to all departmental and company policies and procedures
- Perform any other job related instructions, as requested
Education and Experience:
- High School Diploma or equivalent required
- Minimum of one (1) year of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) is required
- Managed care experience preferred
Competencies, Knowledge and Skills:
- Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environment
- Ability to analyze information
- Communication skills
- Ability to work independently and within a team environment
- Attention to detail
- Proper grammar usage
- Critical listening and thinking skills
- Professional phone etiquette
- Customer service oriented
- Decision making/problem solving
- Change resiliency
- Knowledge of behavioral health systems
- Ability to accurately communicate summary information in a written format
Licensure and Certification:
- Medical Terminology Certificate is preferred
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- Position requires the flexibility to work weekends and/or holidays, as needed
