Company Description: Community Health Programs is a network of health centers and caring professionals that provide outstanding primary and preventive care for patients of all ages. What’s truly unique to CHP is our broad spectrum of support services that extend beyond medical and dental issues to strengthen families and improve children’s well-being. The region is a federally designated rural community and a Medically Underserved Population Area.
Community Health Programs embraces its role as a nonprofit health care provider and community partner. We are a leader in the communities we serve by providing high quality healthcare, dental services, wellness education and family support services. CHP outreach provides free health screenings, insurance enrollment assistance as well as information so people can learn how to take better care of themselves and their families.
Prior Authorization Representative-FT 40 hrs with benefits
High School or Equivalent
Medical Assistant Certification - Preference: Nice to have
Summary: The Prior Authorization Representative is responsible for all aspects of the prior authorization process. The Prior Authorization Representative will collect all the necessary documentation, contacting the client for additional information and completing the required prior authorization in order to proceed with testing. This person will support CHP’s mission, vision, and values and will adhere to compliance protocols as well as CHP’s policies and procedures.
Prior Authorization Representative Essential Duties and Responsibilities:
• Efficiently obtain all authorizations for procedures to be performed prior to patients scheduled date of service.
• Notify scheduling staff of delays in obtaining these authorizations.
• Inform supervisor about any changes or patterns they are seeing in denials of procedures.
• Accept, handle, and process incoming patient telephone inquiries using appropriate customer service skills, clarify and validate patient inquiries, questions or complaints and correct and update patient account information in the computer system.
• Handle and process incoming patient correspondence. Correct or resolve issue, if possible.
• Provide clear explanations of appropriate patient-related policies.
• Maintains patient confidentiality in accordance with established policies.
• All other duties as assigned.
Competencies: To perform the job successfully, an individual should demonstrate the following competencies:
• Subject Matter Expert:
o Is a subject matter expert and keeps knowledge current by attending required trainings and meetings.
o Knowledge of and respect for HIPAA regulations.
o Develops innovative approaches and ideas.
• Business Acumen:
o Understands business implications of decisions; Aligns work with strategic goals.
o Sets and achieves challenging goals.
o Balances team and individual responsibilities.
o Exhibits objectivity and openness to others' views.
o Gives and welcomes feedback.
o Contributes to building a positive team spirit.
• Excellent customer service and interpersonal skills:
o Highest degree of professionalism and ethics:
• Handles issues with tact and diplomacy.
• Reacts well under pressure; Accepts responsibility for own actions.
• Upholds organizational values
o Responds to requests for service and assistance; Meets commitments.
o Takes initiative, follows through, and manages different tasks with quick turn-around time.
o Works well under pressure, and with minimal supervision.
• Organizational skills:
o Follows CHP policies and procedures.
o Completes administrative tasks correctly and on time.
o Excellent time-management skills.
• Verbal and Written Communication Skills:
o Prepares and presents statistical and other reports oral or written as required.
Essential Skills and Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• High School Diploma – Medical Assistant Certification desirable.
• At least one year of experience with the insurance authorization process. Experience with medical terminology required.
• Strong organizational, judgment, communication and analytical skills.
• Ability to multi-task and perform multiple priorities.
• Cooperative and professional behavior toward patients, peers, providers, management and visitors.
• Ability to promote favorable image with patients, providers, insurance companies and general public.
• Ability to make decisions and solve problems.
• The ability to contribute in a team environment and/or independently, to provide excellent customer service.
• Working knowledge of Microsoft Office and Athena desired