Prior Authorization Specialist

Company: Aerotek
Location: Appleton
Posted on: February 23, 2021

Job Description:

Description:Individual will be responsible for naming prior authorizations. When a prior authorization (PA) is sent in from the doctor's office it goes in to big fax box. Each fax then is manually opened and attached (using Navitus' claims processing system) to the member that it has been sent in for. Once it is attached to the member, the individual will follow a strict criteria on how to "name" the fax so that the PA specialists know which fax to work on first.Will be on the phones very little if at all with doctors and members verifying information and processing most of the time- Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit.- Communicate prior authorization criteria to providers.- Act as a provider help desk specialist to aid providers in submitting prior authorization requests, providing formulary product information, and communicating prior authorization request status.- Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs- Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner.- Utilize all available resources to ensure that the correct and complete answer is given to all inquiries.- Prioritize work appropriately and as assigned by leadership.- Learn and apply processes and changes to those processes.- Learn, abide by, and help enforce all departmental procedures.- Actively participate in team meetings, coaching sessions, and daily operations.- Participate in ad hoc or regularly scheduled Prior Authorization projects or projects for other Navitus departments.- Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements.- Participate in mandatory and voluntary learning opportunities and apply new information appropriately.- Utilize work down time for personal and professional development through such activities eLearning classes, participation in the Navitus CPhT program, and by continually reviewing all available resources used in prior authorization processing.- Maintain scheduled hours and demonstrate flexibility to aid in hour coverage.- Support the Navitus mission statement in a professional and responsible manner.Skills:medical claims, healthcare, pharmacy, medicare, medicaid, cs rep, PBM, medical, pharmacy techician, member serviceTop Skills Details:customer servicedata entrymedicalAdditional Skills & Qualifications:Must: -6+ months of Call center experience or office experience -Excellent customer service, computer skills and typing skills -Basic knowledge of Microsoft Office (word and excel) and internet required. -Strong communication skills -Tech savvy-Plus: Bachelor's degreeExperience Level:Entry Level About Aerotek:We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Keywords: Aerotek, Appleton , Prior Authorization Specialist, Other , Appleton, Wisconsin