Optum - Eugene, OR
posted 2 months ago
Full-time - Entry Level
Remote - Eugene, OR
Insurance Carriers and Related Activities
About the position
The Prior Authorization Specialist plays a crucial role in ensuring that patients receive timely access to necessary medical services by managing the prior authorization process for procedures, services, and medications. This position involves working closely with patients, healthcare providers, and insurance companies to facilitate approvals and address any issues that may arise, all while maintaining confidentiality and adhering to company policies.
Responsibilities
- Obtain insurance prior authorization for patient prescriptions, treatments, services, or procedures.
- Perform re-authorization for additional units and retro-authorization requests as allowed by payers.
- Appeal prior authorization denials and facilitate peer-to-peer reviews as needed.
- Document authorization details in the patient's medical record and notify clinical staff of benefit limitations and authorization status.
- Monitor pre-auth denials for trends and provider documentation issues, escalating to Lead or Supervisor as appropriate.
- Meet or exceed productivity expectations to ensure timely processing of requests.
- Assist Operation teams with processing externally referred patients.
- Ensure accurate registration and insurance loading into the system, making necessary corrections.
- Escalate issues or concerns to the appropriate department or manager as necessary.
- Maintain strict confidentiality and perform other duties as assigned.
Requirements
- High School Diploma / GED
- Must be 18 years of age or older
- 1+ years of experience in a medical billing office, medical office setting, or insurance company, including processing claims and knowledge of CPT, ICD-10, and HCPC coding.
- Ability to work full time (40 hours/week) Monday - Friday with flexibility for 8-hour shifts.
Nice-to-haves
- Familiarity with payer authorization processes including interfacing with payers via calls, fax, or portals.
Benefits
- Paid training
- Comprehensive benefits
- Career development opportunities
