Prior Authorization Specialist

Mercy is seeking a dedicated and detail-oriented Prior Authorization Specialist to join our team. As a Prior Authorization Specialist, you will play a crucial role in ensuring that our patients receive timely and appropriate care by obtaining prior authorization from insurance companies. We are looking for someone with strong communication and organizational skills, as well as a thorough understanding of insurance policies and procedures. If you are passionate about providing exceptional patient care and have the necessary qualifications, we would love to have you on our team at Mercy.

1. Obtain Prior Authorization: The primary responsibility of the Prior Authorization Specialist is to obtain prior authorization from insurance companies for medical procedures and treatments. This requires a thorough understanding of insurance policies and procedures.
2. Communicate with Insurance Companies: The Prior Authorization Specialist will be responsible for communicating with insurance companies to gather necessary information and submit prior authorization requests. This requires effective communication skills and the ability to build relationships with insurance representatives.
3. Ensure Timely Approvals: It is the responsibility of the Prior Authorization Specialist to ensure that prior authorizations are obtained in a timely manner to avoid delays in patient care. This may involve following up with insurance companies and providing necessary documentation.
4. Maintain Detailed Records: The Prior Authorization Specialist will be responsible for maintaining accurate and detailed records of all prior authorization requests, approvals, and denials. This information may be used for reporting and analysis purposes.
5. Collaborate with Healthcare Team: The Prior Authorization Specialist will work closely with healthcare providers and other members of the healthcare team to obtain necessary information and ensure that prior authorization requests are completed accurately and in a timely manner.
6. Stay Up-to-Date on Policies and Procedures: It is the responsibility of the Prior Authorization Specialist to stay informed about changes in insurance policies and procedures to ensure that all prior authorization requests are compliant and meet the necessary requirements.
7. Provide Exceptional Patient Care: The Prior Authorization Specialist plays a crucial role in ensuring that patients receive timely and appropriate care. This requires a commitment to providing exceptional patient care and advocating for their needs.
8. Maintain Confidentiality: As a member of the healthcare team, the Prior Authorization Specialist must adhere to strict confidentiality policies and procedures to protect patient information.
9. Attend Trainings and Meetings: The Prior Authorization Specialist may be required to attend trainings and meetings to stay up-to-date on industry changes and to improve skills and knowledge related to the role.
10. Collaborate with Billing and Coding Teams: The Prior Authorization Specialist will work closely with the billing and coding

According to JobzMall, the average salary range for a Prior Authorization Specialist in Ardmore, OK 73401, USA is $34,000 - $45,000 per year. This may vary depending on factors such as experience, education, and job location.

Mercy Health Foundation is a nonprofit organization dependent on the generosity of caring individuals to support Mercy’s mission of delivering compassionate care and exceptional service to the St. Louis community.