About this role

Monitors accounts routed to precertification and prior authorization work queues
Clears work queues by obtaining all payer specific financial clearance requirements in accordance with established management guidelines
Maintains knowledge of and complies with insurance companies’ requirements for obtaining pre-certifications/prior authorizations/referrals
Acts as subject matter experts in navigating both the BMC Community and the payer world
Supports BMC staff at all levels for hands-on help understanding and navigating financial clearance issues
Uses appropriate strategies to underscore the most efficient process to obtaining authorizations
Obtains and clearly documents all pre-certifications/prior authorizations for scheduled services prior to admission within the Epic environment
Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients’ scheduled services
Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required pre-certifications/prior authorizations
Escalates emergent and elective accounts that have been denied or will not be financially cleared within 3 days of admission

High School Diploma or GED required
Associates degree or higher preferred
4-5 years medical billing/denials/coding/and/or inpatient admitting experience desirable
General knowledge of healthcare terminology and CPT-ICD10 codes
Complete understanding of insurance is preferred
Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.
Knowledge of and experience within Epic is preferred.
Technical proficiency within assigned Epic work queues and applicable ancillary systems, including but not limited to: ADT/Prelude/Grand Central, HB & PB Resolute.
Proficiency in Microsoft Suite applications, specifically Excel, Word, and Outlook.

Prior Authorization Specialist

Key skills