COMPANY WEBSITE: https://freedomhealthcare.biz/
COMPANY PHONE NUMBER: (667) 770-6320
HUMAN RESOURCES PHONE NUMBER: (410) 372 4513
POSITION TITLE: PRP Prior Authorization Specialist
ALTERNATE TITLE(S): PRP Prior Authorization Specialist
COMPANY: Freedom Health Systems, Inc.
DIVISION: Operations Division
DEPARTMENT: Accounts Receivables Department
UNIT: Prior Authorization Unit
CLASSIFICATION: W8BEN Independent Contractor. 40 hours per week. Exempt.
COMPENSATION RANGE: $5.00 per hour
WORK SCHEDULE: Monday – Friday, 8:00 AM - 5:00 PM
ACCOUNTABLE TO: Prior Authorization Unit Supervisor
ACCOUNTABLE FOR: All Prior Authorizations Specialists
ANTICIPATED TRAVEL: 0% of the time.
SUMMARY OF POSITION RESPONSIBILITIES: The Prior Authorization Specialist is responsible for reviewing and processing prior authorization requests for medical services and procedures. This role involves verifying insurance coverage, obtaining necessary approvals from insurers, and ensuring compliance with relevant regulations and organizational policies.
SCHEDULED DUTIES AND RESPONSIBILITIES:
- Responsible for requesting and updating PRP Authorizations
- Speak with clients during the intake process regarding insurance verification and authorizations.
- Check insurance eligibility every time PRP authorizations are being requested.
- Reviewing documents needed for requesting PRP Authorizations. (Initial, Concurrent)
- Requesting necessary documents required in requesting PRP Authorizations. (Initial, Concurrent)
- Requests initial PRP Authorizations for new intake clients.
- Reviews expiring PRP Authorizations and requests concurrent authorizations when documents are complete.
- Weekly meeting with the PRP Director and the billing department.
- Reviewing tickets for Authorizations requests
- (Additional tasks) Communicating with NAACPKWVA members to remind them of the General Body Meeting every month.
- (Additional tasks)Attend and moderates during General body meetings
UNSCHEDULED DUTIES AND RESPONSIBILITIES:
- Participate in external and internal audits/surveys (CARF/CSA/OHCQ) as directed by the supervisor.
- Participates in quality assurance and performance improvement plans by completing periodic audits or other activities to ensure regulatory compliance and/or improve service delivery.
- Assist the supervisor, HR, or management with any work-related tasks as requested.
- Responsible for following regulations of COMAR, CARF, any other regulatory body, and company policies/procedures related to your scope of work.
- Co-facilitating orientation of all new hires if requested.
- Support the maintenance of a safe environment by participating in training and drills as requested.
- Advise the supervisor on the development and implementation of protocols to better enhance the efficiency of day-to-day operations effecting change when approvals are made.
- Troubleshoot and abate any issues that could adversely affect the day-to-day operations.
- Report to the Supervisor daily and as requested. Report deviation of operational standards to CEO daily.
- Check emails and company group texts at least every 30 minutes while on duty; respond accordingly.
PHYSICAL DEMANDS: Regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.
WORKING CONDITIONS: Remote work environment
DISCLOSURES: The specific statements shown in each section of this job description are not intended to be all inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. The job’s responsibilities/tasks may be modified and/or expanded over time. Company will inform the personnel member when changes in the respective job description are made.
