Knoxville Hospital and Clinics strive to be your healthcare destination, building on compassion and innovation. We are committed to faithfully providing exceptional healthcare. The values we hold true are Teamwork, Innovation, Compassion, Integrity, Service, and People-Centered.
This is a Full-Time position working 40 hours a week Monday-Friday.
The Prior Authorization Specialist is responsible for processing patient referrals to specialists and contacting the insurance company to obtain prior authorization for ordered procedures. Make outside appointments and specialty appointments, give demographics, verify provider accepts patient’s insurance and complete insurance referral so patient’s insurance will pay at maximum level. Call patient with appointment date, time, location and directions, fax medical records, office dictations, labs, x-ray(s), etc., Contact insurance companies to see if prior authorization is needed for MRI’s, CT’s, nuclear scans, physical therapy, and other procedures.
Essential Functions
- Facilitate referrals for patients by faxing pertinent information to Specialty office.
- Verify provider accepts patient’s insurance and complete insurance referral so patient’s insurance will pay at maximum level.
- Call patient with appointment date, time, location and directions, if applicable.
- Contact insurance companies to see if prior authorization is needed for ordered procedures
- Provide accurate documentation in EHR.
- Initiate consultation referral loop.
- Call insurance company to verify benefits and obtain pre-certification if necessary.
- Other duties as assigned.
Job Requirements
- Must be a high school graduate or equivalent. Experience in the health care field, or at least one year of experience an equivalent of education and experience that would provide the required knowledge, skills and abilities.
- Regular and predictable attendance is a required function of this position.
- Working knowledge of medical terminology, and billing code procedures.
- Previous clinic experience is preferred but not required.
- Prefer person with experience with insurance companies that require prior authorization and/or pre-certification.
- Required to complete all annual competency training and maintain license and/or certification.
This is a Full-time position and is eligible for benefits for medical, dental, vision, flexible spending accounts, retirement plan with company match of up to 6%, accrued hours for vacation and sick time, paid holidays, and company benefits for employee life, employee AD&D, short term and long-term disability.
