Prior Authorization Specialist

POSITION SUMMARY: The RCC Authorization Coordinator's primary responsibility is to perform stationary, telephonic communication for authorization of rehab services for managed care and insurance customers, with the goal to capture reimbursable managed care and commercial insurance revenue associated with outpatient services, in a timely and accurate manner to maximize timely billing. This position involves a variety of assignments requiring confidentiality and familiarity with the operating details of the overall company.

RESPONSIBILITIES/ACCOUNTABILITIES:

Authorization:

1. Provide professional support to Rehab Services Operations personnel by obtaining all authorizations on all outpatient managed care and commercial insurance customers in accordance with HIPAA regulations in handling patient confidential information.

2. Understand each managed care and commercial insurance plan's authorization/referral process and medical necessity requirements. Update quarterly or as necessary.

3. Maintain an ongoing tracking log of all referrals' open authorizations/re‐authorizations by facility by plan.

4. Navigate insurance plan portals to understand benefit data and patient specific information (primary care physician, etc.) and generate referrals and authorizations if necessary.

5. Communicate regularly and consistently concerning any patient or plan updates, via e‐mail and telephone, to rehabilitation and/or facility representatives.

6. Maintain and verifies accuracy of records of correspondence, reports, and related matters.

7. Assist in compiling and distributing activity reports to supervisor.

a. Utilize proprietary software systems, e.g. ROX, etc., in order to accomplish all day‐

to‐day tasks, and create the related electronic documentation in order to ensure access to

information for all concerned.

8. Educate new rehabilitation and facility staff as necessary concerning the authorization process and the role of the RCC Authorization Coordinator.

9. Work with Managed Care Billing and Rehab Service personnel on billing/collection issues as required to accomplish payment for outpatient services authorized and rendered.

Administrative Support:

a. Answer and screen phone calls and/or emails.

b. Type reports, memos, letters, etc. which often involves matters of a confidential and

technical nature.

c. Prepare and maintain files of correspondence reports and related matters.

d. Assist in compiling and distributing all standardized departmental reports.

3. Performs other related duties as required.

SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS:

1. High school diploma or related experience is required for this position.

2. Familiarity with insurance terminology is preferred.

JOB SKILLS:

1. Strong organizational skills and excellent verbal and written skills.

2. Ability to successfully multi‐task under pressure and in stressful situations while maintaining professionalism at all times intact and poise.

3. Demonstrates good judgment and initiative in selecting the most effective work methods and tools and be able to prioritize your work.

4. Must have the ability to exercise administrative judgment within general guidelines.

5. Must possess the ability to positively interact with employees at all levels of the organization and the general public.

6. Demonstrates intermediate skills with Microsoft Office, especially with Outlook, Excel and Power Point. Comfortable learning and using proprietary business software applications.

7. Must have the ability to accomplish rapid computer data entry.

8. Superior internal and external customer service skills.

PERFORMS RELATED DUTIES:

1. The RCC Authorization Coordinator interacts with Corporate, Area and center‐based staff on a variety of professional levels.

1. S/he carries out other tasks as requested in situations where additional support may be required

Job Type: Full-time

Pay: Rs80, Rs90,000.00 per month

Experience:

• authorization: 2 years (Preferred)

Language:

• English (Preferred)

Location:

• Lahore (Preferred)

Work Location: In person