Job Description
The Prior Authorization Specialist (Financial Clearance I) at our healthcare client will ensure all required pre-certifications and prior authorizations are obtained for scheduled outpatient services prior to the date of service, in accordance with payer and hospital requirements.
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Skills and Requirements
High School Diploma or GED Equivalent
2+ years of Prior Authorization Verification Experience
2+ years of experience in pre-certification initiation in a healthcare/ health office setting
Prior insurance experience
Hands-on experience with insurance portals, including:
Availity, Carelon, Telligent (HMO referrals and authorizations)
Demonstrates knowledge of Utilization Management Process
Medicare/Medicaid experience and knowledge
Clinical knowledge and understanding of medical services
Epic experience (ask what tools they used)
Experience supporting HMO and PPO plans
Tech Savvy - Proficient in Microsoft Office (Teams specifically)
Excellent communication and verbal skills
Eagerness to learn and grow within a company, likes overtime, hardworking - Bachelor's degree
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