Prior Authorization Specialist

CareSource Dayton, OH
Role and Responsibility:

§ Assists with Medical Management processes

§ Convert information obtained from providers/members, (received via fax, phone or mail) into electronic records

§ Facilitate/assist the authorization of benefits for out-of-network providers including completion of appropriate forms that are distributed to physicians' offices, provider relations and the generation of approval letters

§ Assist with authorizations as directed by desk references

§ Complete necessary contact with provider/member to verify newborn information

§ Input required data into system for newborns

§ Provide authorization number to provider or facility

§ Assist PCC team support as directed

Perform any other job related instructions, as requested


Education / Experience:

§ High School Diploma or equivalent required

§ Minimum of one (1) year of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) is required

§ Managed care experience preferred

Required Competencies / Knowledge / Skills:

§ Basic level PC experience in a Windows based environment

§ Ability to analyze information

§ Communication skills

§ Ability to work independently and within a team environment

§ Attention to detail

§ Proper grammar usage

§ Critical listening and thinking skills

§ Proper phone etiquette

§ Customer service oriented

§ Decision making/problem solving

§ Change resiliency

§ Knowledge of behavioral health systems

§ Ability to accurately communicate summary information in a written format

Licensure / Certification:

§ Medical Terminology Certificate Preferred


Working Conditions:

General office environment; may be required to sit/stand for long periods of time

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