Prior Authorization Specialist

Position Title: Prior Authorization Specialist

Department: Business Office

Supervisor's Title: HIM/Business Office Manager

IHA# Position Summary:

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures performed at Valor Health. Developing and implementing prior authorization workflow, policies, and procedures. Principal Functions and Responsibilities:

• Contact insurance carriers to verify patient's insurance eligibility, benefits, and requirements.
• Request, follow up and secure prior authorizations prior to services being performed at Valor Health.
• Prioritize incoming authorization requests according to urgency.
• Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.
• When necessary, work with billing specialist to obtain a retro authorization.
• Assist with medical necessity documentation and submit medical records to expedite approvals and ensure that appropriate follow up is performed.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Responsible for reviewing all encounters and mailing out Consolidated Summary of
• Attends and participates in meetings as requested.
• Performs other duties as assigned.