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Prior Authorization Specialist

Company: SureCompanies
Location: Santa Ana
Posted on: January 12, 2021

Job Description:

Description:
SureCo is a PURPOSE driven company that's dedicated to disrupting our broken healthcare system. We're 100% focused on driving down the cost of healthcare and improving the quality of care for all of us. SureCo and its subsidiaries and partners are at the forefront of health care change in the U.S. Serving patients, consumers, and enterprises. We focus on innovative technologies, new care paradigms, all focused on aligning our incentives with our customers. Established in 2016 we've grown from 10 to over 100 (and counting) Sureconians - what we call our awesome team members!If you are looking for a company focused on making real change, high energy, and team-driven performance then you've found it here at SureCo. Our people are inspiring and are inspired by what we do, who we get to do it with, and who we do it for.Key Responsibilities

  • Screens and prioritizes incoming Prior Authorization requests.
  • Supports clinical staff (nurses, physicians, etc) involved in the Prior Authorization process.
  • Process incoming requests, including completing the authorization for specific and limited services, based on established guidelines.
  • Forwards authorization requests that require clinical judgment to Prior Authorization nurse, Manager, or Medical Director.
  • Maintains a full caseload while meeting or exceeding designated metrics and turn-around time-frames.
  • Answers inbound calls from providers and other departments, verifies member eligibility and enters the information necessary to complete the caller's request into the designated database.
  • Identifies and informs callers of network providers, services, and any other available member benefits.
  • Informs providers of the decision on their requests, per department procedure.
  • Assists with the resolution of escalated member or provider inquiries related to Prior Authorization.
  • Serves as subject matter expert for members, providers, and internal departments to promote an understanding of Prior Authorization requirements and processes.PM20.

    Requirements:
    • Requires an education level of at least a high school diploma or GED; Associate's or Bachelor's degree is a plus.
    • Prefers, but does not require, a Certified Nurse Assistant (CNA) or Medical Assistant (MA).
    • Requires exceptional phone / customer service skills, as well as very strong computer user skills.
    • At least 1-2 years' Prior Authorization, Claims, Utilization Review, or Care Coordination experience.
    • Prefer around 1 year at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc).
    • Requires basic to intermediary familiarity with Medical terminology (1-3 years direct experience).
    • Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
    • Knowledge of health care delivery system, Medicaid/Medicare and related state programs is required.
    • Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
    • Must have a minimum of 30-40 wpm typing with a high level of accuracy.Why us?This is an amazing opportunity to join a growing team at a fast-paced, mission-driven startup. You will be an integral part of the team with a high level of responsibility and room for growth.Our business is fast-paced and will continue to evolve. As such, the duties and responsibilities of this role may be changed as directed by the Company at any time to promote and support our business needs.SureCo is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, protected veteran status, or any other basis protected by applicable law and will not be discriminated against on the basis of disability. PI128465230

Keywords: SureCompanies, Santa Ana , Prior Authorization Specialist, Other , Santa Ana, California

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