Prior Authorization Specialist

Job Description

The Prior Authorization Specialist is responsible for coordinating with patients and insurance providers as needed. The Prior Authorization Specialist manages verification and follow-ups on medically necessary documentation, ensuring accuracy and clear communication. The Prior Authorization Specialist should be a reliable, proactive, and positive individual who thrives in a team-oriented environment.

Responsibilities:

• Answer patient or insurance phone calls in a friendly, positive and professional manner while always providing superior customer service.
• Generate and submit necessary pre-authorization/pre-determination request.
• Communicate with patients regarding insurance concerns.
• Document issues and follow-up responses from all the teams in a timely manner.
• Reviews explanations of benefits for payment accuracy, denials, appeals.
• Provide information to insurance carriers or patients regarding patient accounts.
• Obtain insurance GAP's and LOA's.
• Coordinate with the Authorization Supervisor on cases requiring prior authorization
• Maintain accurate documentation of all insurance communications in the practice management system
• Submit authorizations for all surgeons.
• Comply with HIPAA regulations..
• Become acquainted with the treatments offered by the practice.
• Patient Customer Service.

Education and Experience:

Required
• High school diploma or equivalent
• Solid knowledge of insurance terminology, EOBs, and claims processes
Preferred
• Experience in plastic or reconstructive surgery
• Out-of-Network Experience
• Experience working directly with major commercial payers

Skills and Abilities:

• Must be able to multitask.
• Strong attention to detail and organizational skills.
• Solid computer skills, including knowledge of Microsoft Excel and Word; internet savvy.
• Excellent communication and customer service skills.
• Ability to keep up and work within a fast-paced environment.
• Commitment to excellence and high standards.
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.
• Ability to effectively communicate with people at all levels and from various backgrounds.
• Must be able to speak, read, write, and understand the primary language used in the workplace
• Professional appearance and demeanor.

Core Competencies: Client Focus - Manage difficult or emotional customer situations; Respond promptly to customer needs; Solicit customer feedback to improve service; Respond to requests for service and assistance; Meet commitments. Work Location: One location

• Oral Communication - Speak clearly and persuasively in positive or negative situations; Listen and get clarification; Respond well to questions.
• Teamwork - Balance team and individual responsibilities; Exhibit objectivity and openness to others' views; Give and welcome feedback; Contribute to building a positive team spirit; Put success of team above own interests; Able to build morale and group commitments to goals and objectives; Support everyone's efforts to succeed.'
• Work Remotely - No

Work Environment

• Standard in-office position with significant phone, portal, and system-based work.

Rowe Plastic Surgery is a leading provider of aesthetic and reconstructive procedures, committed to
delivering exceptional patient care in a supportive and professional environment. With multiple
locations across the region, our team of board-certified surgeons, clinicians, and administrative
professionals work collaboratively to help patients look and feel their best. We pride ourselves on
innovation, patient satisfaction, and a strong culture of excellence and compassion.