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Prior Authorization Submit Specialist

 

Position Overview:

Serves as a patient's advocate during the Prior Authorization approval process.

Status: Full Time, Non-Exempt

Reports to: Prior Authorization Team Lead

Positions reporting to this position: None

Department: Prior Authorization

Location: Dallas, TX

 

Education / Licensing Requirements:

High School Diploma or GED required. 

 

Experience Requirements:

1-2 years’ experience in a high volume prior authorization environment preferred.

 

Essential Skills/Experience

  • Organizational skills
  • Proven time management skills
  • Team player
  • Accurate data entry skills
  • Excellent attention to detail
  • Proven ability to prioritize and multi-task

Characteristics

  • Sense of urgency

  • Organized, detail-oriented; catches errors early

  • Ethical; respects confidentiality


Responsibilities

  • Communicates with insurance carriers and the physician in order to complete patient prior authorization.
  • Analyze all patient documents to anticipate any issues that may occur with the prior authorization approval.
  • Completes all necessary insurance documents, transmitting them for approval.
  • Communicates with the physician’s office throughout the PA process.
  • Responsible for reporting all customer complaints.
  • Responsible for communicating with the physician’s office if a PA has been not been approved. Based on physician request, appeal may be required.
  • Responsible for LMN reviews
  • Knowledgeable regarding Senderra’s community values and demonstrates them daily.
  • Participates in staff meetings, conference calls, and other meetings, as needed.
  • Performs other incidental and related duties as required

Working Conditions

  • Fast-paced environment.
  • Requires normal vision (corrected) both close and distant.
  • Requires normal hearing levels (corrected).
  • Requires working at a desk to use a phone and computer for extended periods of time. Requires sitting, bending.
  • Uses office equipment and machinery effectively.
  • Requires normal finger dexterity for keyboarding.
  • Works effectively with frequent interruptions.
  • Lifting requirements of 15 pounds occasionally.
  • Minimal travel <10%.