Revenue Cycle Specialist, Prior Authorization – Norwood, OH

Revenue Cycle Specialist – Prior Authorization

RESPONSIBILITIES:

The Revenue Cycle Specialist in the Authorization division is responsible for the day-to-day workflow, and process management of the prior authorization process. This includes facilitating prior authorization request submission, responses, and documentation to ensure payment. Coordination with department leadership will ensure standards are met by not only department or organization policies and procedures but also with payer submission guidelines.
 

KNOWLEDGE SKILLS, AND ABILITIES

• Identifies patients and services requiring prior authorization from the payer. Collaborate to establish and work to improve the efficiency of the process.
• Prepares and submits prior authorization requests to payers via appropriate methods of submission (fax, portal, phone, other).
• Monitors outstanding requests for a response from the payer and identifies and executes appropriate next steps.
• Actively follows up with payers on requests without response and identifies and executes appropriate next steps.
• Works with other departments within organization to resolve outstanding documentation or other process-related issues.
• Keeps updated on all authorization, billing and other payer regulatory or requirement changes.
• Assists billing team with authorization-related claims rejections/denials.
• Completes work within appropriate time to assure compliance with departmental standards.
• Demonstrates knowledge of, and supports, clinic mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Performs other duties as required.
• Assure documentation complies with regulatory agency requirements and best clinical practices.
• Adhere to the organization’s policy, procedures and professional code of ethics
• Self-motivated and self-directed; able to work without supervision.
• Ability to prioritize and manage multiple tasks and competing priorities.
• Exceptional communication and interpersonal skills.
• Analytical and problem-solving skills with attention to detail.
• Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel); working knowledge of billing software a plus.