PRIOR AUTHORIZATION SPECIALIST

Position Title: Prior Authorization Specialist

Department: Business Office

Supervisor’s Title: HIM/Business Office Manager

IHA# Position Summary:

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures performed at Valor Health. Developing and implementing prior authorization workflow, policies, and procedures. Principal Functions and Responsibilities:

1. Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.
2. Request, follow up and secure prior authorizations prior to services being performed at Valor Health.
3. Prioritize incoming authorization requests according to urgency.
4. Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.
5. When necessary, work with billing specialist to obtain a retro authorization.
6. Assist with medical necessity documentation and submit medical records to expedite approvals and ensure that appropriate follow up is performed.
7. Review accuracy and completeness of information requested and ensure that all supporting documents are present.
8. Responsible for reviewing all encounters and mailing out Consolidated Summary of
9. Attends and participates in meetings as requested.
10. Performs other duties as assigned.