PRIOR AUTHORIZATIONS-1570

## Prior Authorization Clerk-
**ESSENTIAL FUNCTIONS:**

• Initiates and process prior authorization requests from healthcare providers for medical procedures and surgical services.
• Verify patient insurance coverage and benefits to determine requirements for prior authorization and collaborate with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes.
• Maintain accurate records of authorization requests, approvals and denials
• Communicate with providers and front-end office, insurance companies, and patients regarding authorization status, requirements and appeals.
• Prepare and submit prior-authorization appeal requests as necessary
• Communicates with patients their copay, out-of-pocket, co-insurance and deductible amounts.
• Familiarity with insurance plans, authorization processes and coverage policies
• Accurate data entry and record keeping.

**KNOWLEDGE/SKILL/ABILITIES:**

• Proficiency in using electronic medical records systems
• Understanding medical terminology, procedures, and healthcare regulations
• Clear and effective communication and verbal skills
• Accurate data entry and record keeping
• Ability to resolve issues related to authorization request and denials.
• Ability to work independently and professionally.

**EDUCATION AND EXPERIENCE**

• High School Diploma and or GED
• Previous experience in healthcare medical billing and insurance authorization, preferred
• Ability to work overtime to meet deadlines or handle urgent authorization request.

**AGE-RELATED COMPETENCIES:** Demonstrates the basic knowledge and skills (cognitive, technical and interpersonal) necessary to identify age-specific patient needs appropriate for all age groups.

**Information Management:** Treats all information and data within the scope of the position with appropriate confidentiality and security.

**Risk Management/Quality Management/Safety:** Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.

**ENVIROMENTAL CONDITIONS:** Work environment consists of daily patient contact, which may include exposure to blood, or other body fluids.

## Qualifications

**MINIMUM POSITION QUALIFICATIONS:**

• **Education** – High School Diploma
• **Work Experience –** Customer service experience preferred, good communication skills required, bi-lingual capabilities preferred. Minimum of one year of prior authorization experience preferred.
• **Training** – N/A
• **License/Certification** – N/A