Prior Authorization Specialist – Green Bay, WI

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This position is full-time, 40-hours per week and is full-time benefit eligible. It is in a call center setting with the potential for hybrid or fully remote after one year of training.

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

• High School Diploma and/or GED Required

experience Qualifications

• 1-3 years One year of experience in a medical or insurance role Required

Skills and Abilities

• Display proficient telephone and computer skills with clear and professional speaking abilities.
• Excellent organizational skills.
• Excellent communication skills and follow through with internal and external customers.
• Knowledge of insurance and medical terminology.
• Basic knowledge of current CPT/ICD coding.
• Able to provide exceptional customer service by assessing patient needs, meeting quality standards, and evaluating satisfaction.
• Capable of being empathetic and responsive to patient’s needs by actively listening, asking appropriate questions, and continually looking for ways to provide assistance.
• Able to efficiently multi-task and adapt to fast-paced environments with frequently changing protocols and processes.
• Capable of effectively and positively interacting with staff members throughout the company.
• Promote teamwork and provide a supportive environment throughout the organization.
• Display grammar, spelling, and punctuation knowledge to accurately document patient information.
• Able to work independently and think critically using provided information.

Physical Demands

• Sit – Constantly
• Stand – Rarely
• Walk – Rarely
• Drive – Rarely
• Climb (Stairs/Ladders) – Rarely
• Bend (Neck) – Frequently
• Gross Manipulation (Hands/Arms) – Constantly
• Squat – Rarely
• Twist/Turn (Neck) – Occasionally
• Lift/Carry 0-10 lbs. – Rarely
• Lift/Carry 11-25 lbs. – Rarely
• Lift/Carry 26-35 lbs. – Rarely
• Push/Pull up to 10 lbs. – Rarely
• Push/Pull 11-25 lbs. – Rarely
• Push/Pull 26-35 lbs. – Rarely
• Reach (Above shoulder level) – Rarely
• Reach (Below shoulder level) – Constantly
• Simple Grasping (Hands/Arms) – Constantly
• Fine Manipulation (Hands/Arms) – Constantly
• Gross Manipulation (Hands/Arms) – Constantly

Working Conditions

• Noise – Occasionally

Travel Requirements

• 5%

Hearing Requirements

• Hears Whispers < 3 feet – Constantly</li>
• Hears Whispers 3-8 feet – Constantly

Vision Requirements

• Color Discrimination – Constantly
• Near Vision (Correctable to Jaeger 2 or 20/40 binocular) – Constantly
• Distance Vision (Correctable to Snellen chart 20/40 binocular) – Constantly

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