Prior Authorization Specialist - Sheboygan, WI

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Prior Authorization Specialist

#25-583

Sheboygan, Wisconsin, United States

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Location

Sheboygan MOB-028

Description

This position is full-time, 40-hours per week. It is full-time benefit eligible.

Prior Authorization Specialist

Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.

Job Summary

The Prior-Authorization Specialist at Prevea Health is responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, services and medications. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist will collaborate with healthcare providers, patients, and insurance representatives to obtain the necessary approvals.

What you will do

• Identify and obtain what is required for preauthorization of procedures, diagnostic tests, services and medications. Seeing the process through completion to minimize denial of claims.
• Coordinate with department providers and staff, coding / billing staff, and insurance representatives to ensure understanding of information needed to obtain proper authorization for payment within the appropriate timelines.
• Review and interpret insurance coverage and policy guidelines to determine authorization requirements.
• Communicate with patient as needed for procedures, diagnostic tests, services and medications to provide them with information regarding their coverage.
• Accurately document and communicate final determination in the patient's medical record and to appropriate staff, providers, or patient.
• Work with internal teams to identify and address trends or issues in the prior authorization process.
• Provide feedback and recommendations to improve prior authorization workflows and efficiency.

Education Qualifications

Experience Qualifications

Skills and Abilities

Physical Demands

Working Conditions

Travel Requirements

Hearing Requirements

Vision Requirements

Prevea is an Equal Employment Opportunity / Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov / E-Verify

Position Located In

Sheboygan,WI