Prior Authorization Specialist (Remote Eligible) (Biotech)

General Purpose
The Prior Authorization Specialist provides prior authorization support for behavioral health services provided within the organization from a multidisciplinary team.

To perform this job successfully, and individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Duties/Responsibilities
Initiates prior authorizations as needed with insurance companies as well as retro authorizations and single case agreements.
Collaborate with medical records, medical providers and/or additional service providers to coordinate care and initiate insurance authorizations as needed.
Documents in EHR all patient contacts, insurance contacts, and other important information related to prior authorizations.
Completes CCARS and DACODS.
Insurance verification and eligibility checks.
Serves as an information resource to clinical and intake teams, communicating often and effectively.
Work as part of a multidisciplinary team.
Participates in job-related training sessions and seminars.
Attends required staff meetings and maintains prompt and regular attendance.
Performs other duties as assigned.

Supervisory Duties (if any)
None

Job Qualifications
Knowledge, Skills, and Ability:
Possesses excellent organizational skills.
Knowledge of specific medical/psychiatric illnesses, procedures and treatments.
Excellent interpersonal skills including negotiation skills necessary to work within a team, and with insurance companies
Knowledge of community agencies/resources.
Ability to advocate/negotiate systems for/with patients.
Ability to multitask under stressful situations.
Proficient in Windows and Microsoft Office Software.
Ability to be flexible in work schedule working weekends as well as be self-directed to prioritize and complete tasks.
Ability to work in a busy, high-stress environment.
Ability to prepare and maintain accurate records.
Ability to interpret rules and regulations and understand client records.
Ability to work tactfully and effectively with all constituents.
Ability to prepare clear and concise reports using correct grammar, punctuation, and spelling.
Ability to maintain objectivity and confidentiality.

Education or Formal Training:
HS diploma or GED

Experience
An ideal candidate will have insurance verification experience and a general understanding of prior authorization requirements. DACOD and CCAR experience preferred but not required.

Working Conditions and Other Conditions of Employment
Working Environment:
This job operates in a fast-paced, professional office environment and routinely requires the use of standard office equipment such as computers, phones, photocopiers. The position may require travel to conferences, meetings and branch locations on a regular or intermittent basis. Work may involve moderate exposure to unusual elements, such as extreme temperatures, dirt, dust, fumes, smoke, unpleasant odors, and/or loud noises. In the health center environment, there is potential for contact with blood-borne pathogens and communicable diseases, as well as potential for contact with dissatisfied or abusive individuals. There could be interaction with persons who are mentally ill, disabled, elderly and emotionally upset.

Physical Activities:
These are representative of those which must be met to successfully perform the essential functions of this job.
This is a largely sedentary role but can involve standing or sitting for extended periods of time, bending at the waist, and using hands and fingers to handle and file papers or operate assigned equipment. While performing the duties of this job, the employee is regularly required to talk or hear. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus. Employee may also have to lift 10 to 25 lbs. unassisted.

Conditions of Employment:
Annual TB, federally required drug screening, and Influenza vaccination or compliance with policy and procedure.
Required possession of a valid state driver's license.
Successful candidate must submit to and pass, post-offer drug screen.