PHRN - AR Executive (Prior Authorization) SOB 40K
2 weeks ago
Job Duties and Responsibilities
- Prioritize incoming authorization and referral requests according to queue urgency
- Review patient's clinical and chart documentation related to the service submitted by the provider's office
- Obtain and/or follow up on authorization and referral requests from the patient's payer/s through any of the following methods—depending on the payer's policy:
- Perform outbound calls to payer's authorization department
- Access payer's authorization online portal
- Submit faxes to payer's authorization department
- Respond to payer's clinical questions to be able to proceed with the authorization and referral requests
- Obtain and/or follow up payer's peer-to-peer review requirements and send them back to provider's office for the actual initiation
- Cater inbound calls from payers and perform necessary actions required for the task
- Listen and review voicemail messages from payers then perform necessary actions required for the task
Required Skills
- Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes
- Comprehensive understanding of Medical Terminology
- Prior experience in processing multispecialty authorizations including contact with payers
- 2 years experience of acute hospital experience
- Experience in prior authorization process
- Experience with general computer software (Internet, Word, Outlook, PDF required)
- Proficiency to learn new software programs quickly
- Excellent customer service skills: communicates clearly and effectively
- Excellent verbal and written communication skills
- Professional and effective interaction skills with co-workers, clients, providers, and vendors
- Proven ability to work well individually and as a team member
- Strong attention to detail
- Ability to follow company and account-specific standard operating procedures and policies
- Ability to adapt to constantly changing environment
- Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand
- Ability to remain organized with multiple interruptions
- Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies
- Ability to comfortably receive constructive feedback
Required Experience
- Graduate of Bachelor of Science in Nursing with active PH registered nurse license
- 1–2 years of experience in business process outsourcing preferably
- 1–2 years of experience of US healthcare authorization business
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