PRIOR AUTHORIZATION SPECIALIST

Position Title: Prior Authorization Specialist 

Department: Business Office 

Supervisor’s Title: HIM/Business Office Manager 

IHA# Position Summary: 

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures performed at Valor Health. Developing and implementing prior authorization workflow, policies, and procedures. Principal Functions and Responsibilities: 

1. Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements. 
2. Request, follow up and secure prior authorizations prior to services being performed at Valor Health. 
3. Prioritize incoming authorization requests according to urgency. 
4. Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner. 
5. When necessary, work with billing specialist to obtain a retro authorization. 
6. Assist with medical necessity documentation and submit medical records to expedite approvals and ensure that appropriate follow up is performed. 
7. Review accuracy and completeness of information requested and ensure that all supporting documents are present. 
8. Responsible for reviewing all encounters and mailing out Consolidated Summary of 
9. Attends and participates in meetings as requested. 
10. Performs other duties as assigned. 

Qualifications

Position Qualifications/Requirements/preferences:

1. Minimum Education: High school diploma or equivalent. 
2. Minimum of 3 years’ experience working in healthcare. 
3. Minimum of 2 years’ experience as a Medical Assistant/CAN/LPN
4. Preferred experience with obtaining prior authorizations.
5. Ability to communicate effectively with a wide variety of contacts at all levels of the organization. 
6. Must have strong organizational skills and attention to detail. 
7. Strong work ethic and ability to apply critical thinking to a variety of practical and time sensitive situations. 
8. Working knowledge of Microsoft Office including Word, Excel, and Outlook are required.
9. Consistent professionalism in both presentation and demeanor. 
10. Ability to work with minimal supervision and as a member of a team. 
11. Ability to Flex Schedule to adjust to workflow. 

Working Conditions: 

1. Primarily office work. Positions is flexible to be in suite, remote or hybrid.
2. General Health care environment exposure to patient conditions.
3. Physical Requirements: Standing, walking, bending, stooping, sitting, hand eye coordination, speaking.