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Prior Authorization Specialist (Medicare)

Company: Aston Carter
Location: Appleton
Posted on: January 16, 2022

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 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 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 companies 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 companies mission statement in a professional and responsible manner.Top Skills Details:medical claims, healthcare, pharmacy, medicare, medicaid, cs rep, PBM, medical, pharmacy techician, customer service rep, member serviceSkills & 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


About Aston Carter:

At Aston Carter, we 're dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions - from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.
Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients ' capabilities by seeking solvers and delivering solutions to address today 's workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit Aston Carter is a company within Allegis Group, a global leader in talent solutions.
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.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.

Keywords: Aston Carter, Appleton , Prior Authorization Specialist (Medicare), Other , Appleton, Wisconsin

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