Prior Authorization Specialist
Location: Santa Ana
Posted on: January 12, 2021
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
- Screens and prioritizes incoming Prior Authorization
- 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
- 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
- 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.
- 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
- 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
- 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.
Keywords: SureCompanies, Santa Ana , Prior Authorization Specialist, Other , Santa Ana, California
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