[Hiring] Prior Authorization Specialist @Physician Health Partners, LLC

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves evaluating referral and pre-certification requests in accordance with contractual obligations. • Regularly interacts with physician offices assisting with prior authorizations. • Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills. • Develops and maintains a good working relationship with team members, other departments, medical directors, and provider offices. • Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues. • Answers phones regarding questions related to prior authorization. • Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow. • Follows documented process to review healthcare service requests. • Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills. • Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations. • Participates as a part of the Prior Authorization team by actively interacting with other team members to distribute work fairly and resolve issues. • Evaluates referral and pre-certification requests to determine eligibility and network affiliation. Qualifications • High School diploma/GED; MA or Associates degree highly preferred • One to three years healthcare experience required (medical office, healthplan, etc.) • One to three years utilization management experience highly preferred • Knowledge of medical terminology required • Knowledge of medical coding, NCQA and Medicare Guidelines required • Proven customer service skills required • Excellent written and verbal communications skills required • Skilled in computer competency using Microsoft Outlook, Word and Excel • Ability to work in a windows based environment utilizing numerous programs at once • Ability to work in a fast pace environment • Ability to identify and solve practical problems • Ability to maintain positive and effective work relationships with coworkers, clients, members, and providers • Strong organizational skills • Strong attention to detail Requirements • Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures Benefits • Salary Range: $19.71 - $26.28 Company Description Alpine is growing, and we welcome new talent to our highly collaborative and diverse team. We are passionate about building a leading national organization that enables physicians to focus on the joy of practicing medicine, and supports the ongoing transition to value-based care for senior populations. Alpine brings this same level of passion to employee engagement, career development and progression. Apply tot his job Apply tot his job