Job Description

SouthCoast Health Is Looking For A Full-time Prior Authorization Representative For Our Cardiology Department

Responsible for all the Prior Authorization for patient care. Prior Authorization representative is to provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements. The prior authorization representative will prepare documentation using the online database to assist with obtaining the approvals.

Responsibilities:

• Perform clinical reviews of authorization requests using appropriate criteria.
• Provide accurate and complete documentation with rationale used to approve request.
• Collaborate with various staff within provider networks and case management team coordinate patient care.
• Participate in interdepartmental projects when needed.
• Enter and maintain clinical information in multiple health management systems.
• Communicates with hospitals and outpatient facilities.
• Perform non-clinical duties as assigned by Supervisor.
• Reports to work on a regular and consistent basis.

Qualifications:

• Ability to exercise professionalism in dealing with all levels of personnel, patients and patients' families.
• Ability to communicate clearly.
• Ability to perform independently within departments policies and procedures.
• Knowledge of medical terminology.
• Knowledge of procedure (CPT) and diagnosis (ICD 10) coding.

Education/ Experience:

High school diploma. Two years medical office experience, strongly preferred.

Benefits:  

Competitive salary, health, HSA, dental, vision, life, long term disability, 401(K) with employer contribution, voluntary insurance policies (i.e. critical illness, short term disability, life, identity theft). PTO, holidays, and bereavement leave.

EEO, DFW, MFVD.

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