Job Description
40328BR
Extended Job Title:
Prior Authorization Specialist
Org Level 1:
Texas Tech Unv Hlth Sci Ctr El Paso
Position Description:
Responsible for verifying insurance coverage and eligibility, and obtaining required pre-authorizations for medical
procedures, treatments and services.
Requisition ID:
40328BR
Optional Attachments:
Transcript
Travel Required:
Up to 25%
Major/Essential Functions:
Handle authorization process and obtain pre-certification approvals prior to service.
Submit pre-authorization requests and follow up with payer to ensure timely approvals.
Update resident providers and supervising faculty of delays related to pre-authorization.
Assist providers with treatment plan assessment to determine if pre-authorization is required.
Assist in the development and maintenance of a standardized workflow for the pre-authorization process.
Provide instruction and guidelines on coding and pre-authorization processes to faculty, residents and staff.
Assist in the preparation and submission of appeals for denied authorizations, including but not limited to providing additional information or documentation.
Respond and follow-up to patient and insurance inquiries/correspondence in a timely manner and in accordance with departmental expectations/requirements.
Provide leadership team with regular status updates on authorization and denials.
Maintain accurate records and reports of pre-certifications request, approvals, and denials.
Review assigned electronic health record (EHR) Work Queue’s to ensure all errors are cleared and billing has been submitted in a timely manner, and in accordance with departmental expectations/requirements.
Stay current with changes in coding guidelines, regulations and insurance requirements.
Assess and monitor Medicaid/CHIP billing guidelines and regulations while partnering with the Office of Institutional Compliance on corrective action plans related to billing compliance.
Collaborate with revenue cycle team via weekly, biweekly, and/or monthly meetings (as directed) to review payment and denial trends.
Collaborate with members of clinic administration on process improvement to help optimize the pre-authorization processes in the clinics.
Communicate with patients regarding authorization requirements, status updates and financial responsibilities associated with approved or pending authorizations.
Serve as a liaison between clinical providers and insurance payers to address authorization-related issues or inquiries effectively.
Escalate matters of concern to leadership in accordance with departmental expectations/requirements.
Adhere to all policies, procedures and practices (Regents Rules, TTUS, HSECEP OPs, etc.).
Personally demonstrate, display and act in accordance with TTUHSC EP's Values (Service, Respect, Accountability, Integrity, Advancement, and Teamwork).
Serve as a Value's ambassador while actively promoting and encouraging staff across the institution.
Perform all other duties as assigned.
Grant Funded?:
No
Minimum Hire Rate:
Compensation is commensurate upon the qualifications of the individual selected
Pay Basis:
Hourly
Work Location:
El Paso
Preferred Qualifications:
Excellent communication (verbal and written) and interpersonal skills.
Knowledge of basic medical terminology.
Knowledge of CPT and ICD-10 coding. Familiarity with payer authorization processes.
Ability to apply a strong attention to detail to work while meeting required deadlines, targets, goals, and/or metrics. PACS, CHAA or CMA certification.
Previous experience providing support to multiple medical sub-specialties/clinics.
Previous experience working in an academic medical/health sciences center.
Bilingual in English and Spanish.
Campus:
HSC - El Paso
Department:
Clinical Operations SURG
Required Attachments:
Resume / CV
Job Type:
Full Time
Pay Statement:
Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as the institutional pay plan. For additional information, please reference the institutional pay plan website ( .
Job Group:
Information and Records Clerks
Shift:
Day
EEO Statement:
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, disability, genetic information or status as a protected veteran.
Required Qualifications:
Associate's degree plus one (1) year of experience directly related to the processing of prior authorizations; OR
High school diploma or GED plus current certification as a Prior Authorization Certified Specialist (PACS), Certified Healthcare Access Associate (CHAA), or Certified Medical Assistant (CMA); OR
High school diploma or GED plus three (3) years of experience directly related to patient registration, patient scheduling, patient billing/collections, and/or the processing of prior authorizations.
Does this position work in a research laboratory?:
No
Jeanne Clery Act:
The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act is a federal statute requiring colleges and universities participating in federal financial aid programs to maintain and disclose campus crime statistics and security information. By October 1 of each year, institutions must publish and distribute their Annual Campus Security Policy & Crime Statistics Report (ASR) to current and prospective students and employees. To view this report, visit the TTUHSC Clery Act website ( . Texas Tech University Health Sciences Center El Paso
Job Tags
Hourly pay, Full time, Shift work,