Prior Authorization Specialist (healthcare systems)

Contract
Portland, Oregon


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.

Minimum Requirements:

  • 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

Detailed Responsibilities:

  • 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.

Preferred Experience:

  • 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

Education:

  • Associates Degree preferred
  • Prior Authorization Certification Highly Desired
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