Authorization Coordinator De La Pena Eye Clinic ...

The primary function of the Prior Authorization Specialist position is to provide premier customer service to the patient, physician and their office staff by obtaining facility authorizations for patients scheduled at the practice. The Prior Authorization Specialist is responsible for reviewing prior authorization requests and following and established process. This position manages a high call volume of prior authorization services. The position reviews schedules with multiple patient's appointments, verifies or obtains authorization and document authorization information. Communicate authorizations and denials to ordering physicians. Keep records of schedules and authorization requests. The person who fills this position is required to maintain a working knowledge of Managed Care Contracts as well as insurance requirements for authorizations, notifications or referrals. The Prior Authorization Specialist responsibilities may include, but are not limited to: 1. Applying medical knowledge and experience for prior authorize requests 2. Performing detailed medical reviews of prior authorization request or assessment forms according to established criteria and protocols 3. Managing incoming authorization requests and inquiries via fax, computer, telephone, or mail 4. Maintaining accurate documentation on all requests and documenting in the appropriate computer application 5. Initiating direct communication with health care providers involved with the care of the member to obtain complete and accurate information 6. Identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services. 7. Determining if services are a covered benefit and documents pre-authorization information in EMR. 8. Serves as a resource to clients 9. Performs other duties as requested or assigned 10. This role excludes performing any clinical tasks related to patient, to include assessment or evaluation of patient’s medical condition or providing clinical advice or medical care or recommendations 11. Demonstrated knowledge of potential exposure to hazardous materials (. patient body fluids, disinfectant chemicals) and location of SDS sheets 12. Participates in QAPI and Safety Program Qualifications Education: High school education or equivalent. Associates degree preferred Experience: At least one year in Scheduling in a healthcare environment is required Knowledge & Skills Knowledge of anatomy and physiology, medical terminology and disease processes. Organized, detail oriented and able to manage competing priorities. Excellent typing and computer usage skills, including Microsoft Word and Excel proficiency. Knowledge of medical insurance terminology, medical benefits, and billing process. Experience with online benefit verification, working with insurance companies, and knowledge of various types of coverage and policies. Maintain accurate patient insurance records. Good judgement and must have excellent multitasking skills. Resourcefulness in problem solving. Ability to work independently, give attention to detail, prioritize and perform several tasks together without losing concentration. Effective communication skills, written and verbal. Ability to relate with people of diverse backgrounds, provide excellent customer service and solutions to problems.

Created: 2025-11-07