Authorization Specialist Job at Conrad Pearson, Germantown, TN

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  • Conrad Pearson
  • Germantown, TN

Job Description

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GENERAL DESCRIPTION
The Authorization Specialist is responsible for calling insurance companies to obtain prior authorization and precertification for services, procedures and medications.  

ESSENTIAL JOB FUNCTIONS
  • Responsible for prior authorization and precertification of eligible medical services, procedures and medication. 
  • Ensure complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services.
  • Call/navigate insurance websites for authorization requirements and obtain timely authorizations from various insurance companies.
  • Communicate with insurance carriers, both internal and external customers and patients via phone or written correspondence.
  • Update task in the system to include approvals, coinsurance, copay, deductibles and authorization requirements.
  • Initiate appeals for denied authorizations.
  • Prioritize incoming prior authorization and precertification requests according to urgency.
  • Familiar with the practices and job duties at the Wolf River Clinic and all outlying clinics and is able and willing to work at these locations as needed.
  • Communicate regularly with supervisor, keeping him/her apprised of all pertinent information and providing feedback.
  • Ensure compliance for all regulatory requirements including OSHA, CLIA and HIPAA; immediately and accurately document and report occurrences to supervisor; and ensure compliance with all legal and regulatory requirements as outlined in the corporate compliance plan.
  • Support and adhere to all company policies, procedures and management decisions; maintain confidentiality of patients’ medical information; and all confidential administrative related issues.
  • Demonstrate dependability in attendance, punctuality in reporting for work and initiative in completing a full work schedule; meeting or exceeding all established deadlines and utilizing all resources and supplies efficiently and appropriately.
  • Demonstrate the ability to concentrate during the course of the day.
  • Display a positive outlook with a helpful, constructive manner when working with other employees.
  • Demonstrate superior patient relations and interpersonal skills; demonstrate an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public using tact, sensitivity and sound judgment; promote a positive work environment and contribute to the overall efforts of the department and the company.
POSITION REQUIREMENTS
  • Completion of a nursing program from an accredited school is required.
  • Current Registered Nurse (RN) or Licensure Practical Nurse (LPN) is required.  Ten years of clinical experience will be considered in lieu of license requirement requirements.
  • Two years of clinical experience, preferably in a urology practice is required.
  • Excellent oral and written communication, interpersonal, problem solving and organizational skills are required.
  • Occasional overtime, evening and weekend work is required.
ESSENTIAL PHYSICAL REQUIREMENTS
  • Requires prolonged sitting, some bending, stooping and stretching, or performing other work requiring moderate physical exertion.
  • Capacity to maintain physical activity over prolonged periods of time (stamina).
  • Able to see for the purpose of reading information received in different formats including but not limited to paper, computer, reports, bulletins and manuals.
  • Able to hear for work-related purposes.
  • Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
  • Able to lift up to a minimum of 25 pounds.
ESSENTIAL ENVIRONMENTAL CONDITIONS
  • Work is generally performed under normal office working conditions.
  • Normal level of visual strain.
  • Ability to cope with stress caused by public interaction, multiple demands and extraneous noises.
  • Possible exposure to contagious diseases.

Job Tags

Full time, Work at office, Immediate start, Afternoon shift,

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