Prior Authorization Case Manager

Description: Position Overview: Prior Authorization Case Manager The Prior Authorization Case Manager obtains prior authorizations for clients with the goal of ensuring insurance coverage for patient stays and low turnaround times for auth obtainment. The Prior Authorization Case Manager reports to their Supervisor of Prior Authorizations. Key Results Area

• Puts forth best efforts to learn and understand the full training provided upon onboarding.
• Actively responds to clients’ authorization requests within 20 minutes of receipt per each request throughout the day.
• Maintains a full understanding and data input accuracy of Guided Care software for managing client authorization requests.
• Maintain a high level of customer service and professionalism in all methods of communication.
• Completes an average of 180 authorizations per 30 days at 90 days of hire.
• Completes an average of 220 authorization per 30 days at 120 days of hire.
• Maintains an error rate of less than 2 per month after 90 days of hire.
• Complete census verification before or by 11 AM. Communicates with clinical case manager as required.
• Updates supervisor of any new developments on prior auth process specific to health plans and states to ensure upkeep the Guide to Obtain Authorizations.
• Requests authorizations within 20 minutes of client requests, and provides updates to clients minimum three times a day on pending cases.
• Informs supervisor of prior authorizations pending over 72 hours to assist in escalation and client satisfaction.
• Reviews prior auth packet for completeness and is responsible for ensuring correct documentation is submitted to insurance. Is responsible for ensuring only clinical documentation required by insurance is submitted.
• Provide feedback to the supervisor on 1:1 monthly meeting or immediately as necessary if client is not following the guided care prior auth request process.
• Upkeep skilled active listing to ensure a smooth and organized workflow.
• Responsible for updating coverage notes to ensure smooth coverage of caseload.
• Provide support and educations to clients on prior authorization process and software usage as needed.
• Review monthly AR logs prior to the 1st of every month to ensure data is entered accurately for appropriate billing.
• Coordinate and submit all prior auth appeal requests. Follow up with appeals team timely to ensure appeals are being completed by deadline.
• Collaborates with colleagues, helping and handling additional cases during downtime or a lull in individual caseload
• Communicates respectfully with colleagues and leadership.
• Participate in team building and employee appreciation activities arranged by HR.
• Maintains time clock, requests, and takes PTO according to HR policies.
• Other duties as assigned.
• Agree to uphold and practice company principles (GUIDE) in all work-related
• interaction

Requirements:

Requirements

• High School Diploma or GED.
• 3+ years of experience submitting obtaining authorizations in a healthcare setting.
• Skilled nursing admissions or business office experience preferred.
• Independent and self-motivated.
• Innovative and detail-oriented professional with strong research and organizational skills.
• Thrives in a fast paced, high-pressure environment.
• Strong time management with a proven ability to meet deadlines.
• Solid collaborative skills with team and clients.
• Ability to work remotely and autonomously.
• Ability to establish and maintain positive relationships.
• Ability to communicate and exchange information and ideas so others will understand.
• Demonstrate discretion, sensitivity, and ability to maintain confidentiality.
• Quality camera to be used when joining internal and client meetings scheduled via zoom or teams or other video meeting platforms. When participating focuses on the matter at hand. Refrains from actively perform other duties even if work related.
• Joins scheduled client meetings timely, best practice 3 minutes prior to meeting time, to

ensure best self and company representation.

• Microsoft Office proficiency, with the aptitude to learn new programs. Working Conditions/ Physical Demands
• Works in well-lit/ventilated office, and as indicated remotely.
• Must be able to remain in a stationary position and move about the work area intermittently throughout the workday.
• Ability to observe details at close range.
• Constantly operates a computer and other office equipment