Oregon Medical Group Prior Authorization Specialist in Eugene, Oregon
Prior Authorization Specialist
+ + Job Tracking ID: 512611-818858
Job Location: Eugene, OR
Job Type: Full-Time/Regular
Date Updated: May 20, 2022
- Starting Date: ASAP
Hours: Monday-Friday 8am-5pm
Number of Openings: 1
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Oregon Medical Group offers a competitive compensation and benefits package including:
Low cost medical, dental, and vision insurance with $0 copay when seeing an OMG provider
401(k) retirement plan with employer match
Paid Time Off - 4.6 weeks to start
Education assistance and tuition reimbursement
Company paid corporate gym membership
Company paid short term disability
PURPOSE OF POSITION: The Prior Authorization Specialist communicates with patients by analyzing insurance prior authorization requirements. It is the responsibility of the Prior Authorization Specialist to receive, process and document all requirements and to submit the required documents and update the Prior Authorization submission documents if necessary.
EXAMPLES OF DUTIES:
Apply billing and coding principles consistent with government regulatory standards, payer specific guidelines of the health plans and OMG policy.
Assists in the data entry and completion of Authorization forms and notifications. Obtains insurance prior authorization for patients and re-authorization for additional treatments.
Ensures insurance carrier documentation requirements are met and Authorization documentation is scanned and documented in the patient’s medical record.
Documents all information from the authorization forms and ensures that providers are following standard guidelines for adequate reimbursement. It is the responsibility of the Prior Authorization Specialist to communicate if patterns of denials are occurring or being processed inconsistently.
Manages correspondence with patients, physicians, specialists and insurance companies.
Communicates with the other Prior Authorization Specialists, Patient Accounts Service Representatives and Coders to continually monitor changes in the health insurance arena.
Verifies patient’s benefits and ensures proper prior authorization before the patient is scheduled for services. Notifies provider’s office of approved prior authorization and/or denial.
Pre-Screens appointment schedules and works 1-2 weeks out with provider schedules along with checking daily add-ons.
Obtains any/all retro-authorizations in a timely manner.
Appeals denials and/or sets up peer to peer reviews.
Assists with the referral process.
Medication Prior Authorization. Receive all requests for medication prior authorizations from pharmacies. Identify the appropriate form needed. Provide documentation to support the use of the medication by researching the medical record. This will require knowledge of medication classifications, side effects documentation, and dosage documentation. Communicate via fax to the insurance company. Maintain communication with the physician office on the status of the authorization.
Escalates any issues or concerns to the appropriate department or manager as necessary.
Maintain strictest confidentiality.
Work on assigned projects as needed.
Perform other duties as assigned.
Experience and Skills:
Knowledge of reimbursement and claims processing procedures to include billing and collection practices. Basic CPT & ICD-10 coding knowledge. Knowledge of clinic operating policies. Skill in using computer and calculator. Able to examine documents for accuracy and completeness. Able to prepare records in accordance with detailed instructions. Ability to work effectively with patients and co-workers. Ability to communicate clearly, both verbally and in writing.
EDUCATION: Equivalent of a high school diploma.
EXPERIENCE: 2-3 years’ experience in medical billing office, medical office setting or insurance company to include processing claims and a working knowledge of CPT, ICD-10 and HCPC coding.
Full COVID-19 vaccination is an essential requirement of this role. Oregon Medical Group will adhere to all federal, state and local regulations and will obtain necessary proof of vaccination prior to employment to ensure compliance.
TYPICAL PHYSICAL DEMANDS: Requires sitting for prolonged periods of time and some bending, stooping and stretching. Requires hand-eye coordination and manual dexterity necessary for the operation of basic office equipment such as a computer, calculator, photo copier and telephone. May be required to lift up to 25 pounds. Requires the ability to work quickly and accurately under stress.
TYPICAL WORKING CONDITIONS: Work is performed in an office environment. Involves frequent contact with patients and internal staff.
About Oregon Medical Group
Oregon Medical Group provides patients with a single point of access to a full range of comprehensive and coordinated health care, including primary care, pediatrics and over 20 other specialties. Supporting services include on-site labs and x-ray services, a state-of-the-art imaging department, physical therapy, infusion center and more. OMG emphasizes preventative care and healthy living as it cares for patients. Addressing the cause of health issues is as important as treating symptoms; many OMG patients credit their physicians and clinicians for support with health, fitness and other lifestyle choices. Founded in 1988, OMG physicians, clinicians and staff provide care from 10 locations across the Eugene and Springfield areas to help our patients live their healthiest lives. Learn more at OregonMedicalGroup.com.
Our Mission: We collaborate to provide the highest quality, patient-centered care.
Our Vision: Together, we help you live your healthiest life.
Our Values: Servant Leadership – Professionalism – Sustainability