Catapult is looking to bring a Prior Authorization Specialist on to our Product Management team to assist with defining requirements and go-to-market activities for our prior authorization automation solutions. We are looking for an individual who has experience working in a hospital environment ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services.
- 3+ years of Prior- authorization experience in a hospital or health system
- Understanding of insurance requirements for Prior Authorization for Commercial and Government Payors
- Knowledge of medical terminology
- Understanding of CPT codes and vast knowledge of insurance required
- Excellent verbal, written, organizational and customer service skills
- Ability to work independently, meet deadlines and be flexible
- Ability to perform tasks accurately and efficiently when entering data electronically
- Proficient typing/keyboarding skills
- Basic knowledge of Microsoft Office, Excel and Outlook
- Followed prior authorization workflow policies and procedures
- Collaborated with other departments to assist in obtaining prior authorizations.
- Reviewed accuracy and completeness of information requested and ensured that all supporting documents are present
- Received requests for prior authorizations and ensured that they were properly and closely monitored.
- Processed referrals and submitted clinical supporting documentation to insurance carriers to expedite prior authorization processes
- Managed correspondence with insurance companies, clinicians and patients as required
- Documented all prior authorization information including approval dates, prior authorization number in hospital system
- Proactively worked on prior authorizations that were timely
- Secured patients’ demographics and medical information by ensuring that all procedures are in sync with HIPAA compliance and regulation
- Advised providers and their clinical staff when issues arose relating to obtaining prior authorization
- Stayed informed and researched information regarding insurance criteria changes/updates for prior authorization
Essential Functions: (must be able to perform these functions, with or without a reasonable accommodation).
- Develops business requirements for development, including prioritization of Prior Authorization features and functionality desired by clients.
- Assists with documentation of new product development.
- Informs management and other departments of product changes or needs based on new guidelines or specifications.
- Assists with the definition of standard configurations to support common implementation activities.
- Interprets and Codes local medical review policies
- Conducts conference calls with payers and clients.
- Adheres to the company’s attendance policy.
- Acts as a positive role model in all aspects of professional performance.
- Observes safety procedures and personnel policies.
Security Roles and Responsibilities:
- Implement and act in accordance with the organization's information security policies.
- Protect assets from unauthorized access, disclosure, modification, destruction or interference.
- Report security events or potential events or other security risks to the InfoSec department.
- Experience using payer websites for Prior Authorization preferred
- Experience with EPIC, Cerner and Meditech systems preferred
- Experience with Prior Authorization 278 transactions preferred
- Experience working for a software development organization preferred
- Associates Degree preferred
- Prior Authorization Certification Highly Desired