Prior Authorization Specialist

Children’s Clinics is seeking a Full-Time Prior Authorization Specialist.

As a member of the dynamic Prior Authorization team the individual will join a strong transdisciplinary outpatient clinic serving a diverse pediatric patient population with complex medical needs. This position is responsible for both on and off-site services for multiple providers including Primary Care, Specialty provider, Dental, Therapies including Physical, Occupational, Speech Therapy and Audiology. Reviews patient information, diagnosis, CPT and ICD10 service codes with AHCCCS and Commercial payers to establish medical necessity for requested services.

This position is responsible for:

• Appropriately prioritize all prior authorization request/ referrals. Submits for onsite and offsite appointments, outpatient procedures, diagnostics procedures and/ or therapies.
• Reviews future appointments in NextGen on a daily and weekly basis to verify that all required authorizations have been requested, paying close attention to short notice and same day appointments.
• Reviews patient information including diagnosis ICD10 codes, CPT codes and submits authorization request and all required documentation to the appropriate insurance companies.
• Track pending authorizations, follow up on submitted authorizations.
• Processes approved/denied requests with accuracy and meeting timely standards to include data-entry, coordination with offsite providers and clinical staff for scheduling and communication of status and requests.
• Performs other duties as required and assigned

Age of Patients attended to by employee in this position:

• Neonatal (newborn)
• Pediatric (birth-13)
• Young Adult (14-21)
• Adult (21-65)

In addition to competitive salary, we offer you and your family a comprehensive benefits package including:

• Medical, Dental, Vision
• 401(k) with company match
• Group Term Life in addition to voluntary life insurance
• Corporate Care (sick child/adult/pet)
• Pet Care program
• Tuition reimbursement
• Paid Holidays and Paid Time Off
• Supplemental insurance
• Flexible Work Strategies (depending on position)
• And more…

MINIMUM QUALIFICATIONS:

Education:

• High School diploma or general education degree (GED) required

Experience: 

• At least one year in related field and/or experience in a healthcare environment preferred
• Must have thorough knowledge of AHCCCS, CRS and third party insurance prior authorization and referral guidelines
• Experience in precertification, referrals and prior authorization is required. Individual should have a solid understanding of medical terminology and CPT and ICD10 coding practices
• EHR experience (NextGen preferred)

Licenses and Certificates:

• None required

Fingerprint Clearance:

• Employees are required to maintain a current Department of Public Safety Level 1 Fingerprint Clearance Card. Proof of a current fingerprint clearance card must be received within 90 days of employment.

Physical Demands and Work Environment:

The physical demands and work environment described here are representative of that which an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel and talk and hear. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision and ability to adjust focus. While performing the duties of this job, the employee may potentially be exposed to infectious organisms during routine and emergency situations. The noise level in the work environment is usually moderate.

Children’s Clinics reserves the right to make changes to this document at any time in accordance with business needs.  This document is not intended to list all duties of the job.  It is descriptive only of the chief duties and responsibilities.