Responsibilities:
Principal Duties and Responsibilities (*Essential Functions)
- Assign and delegate prior authorization request to team members based on workload and expertise
Monitor team performance, identify areas for improvement, provide coaching and feedback alongside department manager
Conduct regular team meeting to discuss workflow, challenges, and policy updates
Train and mentor new prior authorization specialist on company procedures, payer guidelines and relevant software
Performs duties of Prior Authorization Specialist
- Performs other duties as needed and/or assigned
Knowledge, Skills, and Abilities
- Knowledge of insurance prior authorization and medical terminology
- Demonstrates exceptional customer service skills
- Provides staff feedback and education
Ability to motivate, guide, and develop a team
Acts as reference source for staff (Subject matter expert) prior authorizations, insurance portals, hospital/department policies/procedures
Adheres to and monitors staff authorization work ques
Meets or exceeds all Methodist Hospital employee standards (ex. attendance, productivity, QA, customer service)
Supports all management initiatives
Works closely with other departments to promote efficiency and timely authorizations
Evaluates operations of department and makes recommendations to manager and director
Medical terminology knowledge
Ability to prioritize job functions, work independently and exercise good judgement
Must possess good written and verbal communication skills
Basic computer skills
Education
High School Diploma/GED Equivalent in General Studies is Required
Bachelors Degree in Business/Management is Preferred
Experience
3 Years experience in Prior Authorization Physician office/Hospital based is Required
Certifications and Licensures
Certified Professional Coder (CPC) is Preferred
Model of Care and Conduct
Methodist Hospitals strives for excellence and insists on high standards of conduct and performance in everything we do. Our Model of Care and Conduct is designed to create a positive work environment which Methodist desires for all employees. This is foundational to the high level of patient, family and physician satisfaction we strive for each day. As part of all position’s duties at Methodist Hospitals, all employees are responsible to conduct themselves in accordance with the Model of Care and Conduct and will be evaluated according to these standards of behavior.
