Top 18 Prior authorization specialist Jobs in Columbus

Insurance Verification and Prior Auth Specialist
Ohio Gastroenterology Group —Columbus, OH
- Hybrid work
- Microsoft Excel
- HIPAA
- English
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BH Insurance/Precert Specialist
Nationwide Children's Hospital —Columbus, OH
- Full-time
- CPR Certification
- BLS Certification
- High school diploma or GED
Prior Authorization Specialist
Quiet Waters Clinics —Columbus, OH
- $18 - $25 an hour
- Full-time
- Background check
- Microsoft Excel
- Customer service
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12d
Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
- Weekends as needed
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid time off
- 401(k) matching
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Referral Specialist
Equitas Health, Inc. —Columbus, OH
- $18.13 - $21.78 an hour
- Weekends as needed
- 3 years
- Administrative experience
- High school diploma or GED
- Paid holidays
- Dental insurance
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Referral Specialist
PrimaryOne Health —Columbus, OH
- High school diploma or GED
- Entry level
- Paid holidays
- Disability insurance
Customer Account Specialist
Hexion Inc. —Columbus, OH
- Microsoft Word
- 18 years or older
- Pass drug screening
Client Insurance Specialist
Integrated Services for Behavioral Health —Columbus, OH
- $20.97 - $24.56 an hour
- Hybrid work
- Mid-level
- Organizational skills
- 2 years
- Disability insurance
- Health insurance
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Customer Support Specialist
Kinetics Noise Control —Dublin, OH
- $42,000 - $45,000 a year
- Microsoft Excel
- Microsoft Outlook
- ERP systems
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Central Pharmacy Liaison
AndHealth —Columbus, OH
- Full-time
- Current TB test
- BLS Certification
- Mid-level
- Disability insurance
- Health insurance
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Dental Coordinator
Equitas Health, Inc. —Columbus, OH
- $20.43 - $25.53 an hour
- Weekends as needed
- Dental office
- High school
- Computer literacy
- Paid holidays
- Dental insurance
Quick Apply
3d
Dental Claims Specialist
The Ohio State University —Columbus, OH
- $18.37 - $23.99 an hour
- Full-time
- Background check
- Pass drug screening
- Office

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Reliable transportation, driver’s license, and proof of auto insurance required. Review and complete daily tasks such as scanning, completing referral requests,…
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Insurance Verification and Prior Auth Specialist
Ohio Gastroenterology Group —Columbus, OH
Responds to patient calls about how out of network insurance is handled and provide patient with letter explaining this if necessary.
Quick Apply
BH Insurance/Precert Specialist
Nationwide Children's Hospital —Columbus, OH
CPR certification (based on position and as determined by manager). Obtains insurance prior authorization as needed and documents the verification of benefits…

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Insurance Verification and Prior Auth Specialist

Ohio Gastroenterology Group -
Columbus, OH

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Job Details

Qualifications

High school diploma or GED

Full Job Description

Primary Job Functions[1] (#_ftn1):

Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.
Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with internal departments, physician offices, patients and third-party payers to complete the pre-certification process.
Identifies out of pocket amounts (i.e., copay, deductible, co-insurance), determining the correct coordination of benefits, identifying if a replacement or supplemental plan exists, identifying termed coverage, and identifying if the patient's plan is considered out of network coverage.
Collaborates with internal departments to provide account status updates, including expected out of pocket amounts, coordinate the resolution of issues, and appeal denied authorizations.
Ensures services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance. Notifies ordering providers if authorization/certification is denied.
May need to coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
Maintains files for referral and insurance information, and enters referrals into the system.
Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
Runs system-generated reports to verify insurance verification/authorization is being done timely prior to the patient's date of service; verifies the insurance benefits and eligibility either by phone or online for every patient that is scheduled
Responds to patient calls about how out of network insurance is handled and provide patient with letter explaining this if necessary.
May need to respond to patient inquiries about their insurance benefits.
Assists physician’s office staff with any insurance benefit questions and educate them on any changes to the insurance companies’ verification/pre-certification process for the facility.
Ensures insurance information is verified and entered into the billing system.
Works with Billing Department to assure all insurance information is entered so claims are not denied. May help research any claim issues.
Other duties as assigned.

Secondary Job Functions:

Attend meetings and training sessions
Maintain confidentiality of patient and financial information by utilizing HIPAA guidelines and regulations
Adheres to all Federal, State, and Local laws and regulations as well as policies set forth by Ohio Gastroenterology Group Inc and its related parties

Knowledge, Skills and Abilities

Knowledge of third-party payers and prior-authorization requirements
Understanding of basic medical terminology and procedures
Proficient use of office equipment, such as copier and fax machine, phones, etc.
Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical records systems.
High attention to detail and the ability to multi-task.
Strong time management skills
Ability to work independently with minimal supervision and to manage multiple priorities.
Strong written and verbal communication skills
Ability to effectively communicate with a variety of people under stressful circumstances.

Neat appearance, professional demeanor and pleasant voice
Fluent in English

Credentials and Experience

Must have high school diploma or equivalent
One (1) year of experience and relevant knowledge of revenue cycle functions, insurance eligibility, or prior authorization in a healthcare setting preferred
- Experience with eClinicalWorks a plus

Physical Demands

Must be able to bend over (frequent), climb stairs (frequent), sit (frequent), stand (frequent), stoop (frequent), walk (frequent) and type on keyboard (frequent).

Work Environment

Minimal medical office exposure that may require contact with adult patients
Office workstation environment with numerous employees

[1] (#_ftnref1) Critical features of this job are described under this heading. They may be subject to change at any time due to reasonable accommodation or other reasons,

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

prior authorization specialist jobs in columbus

Insurance Verification and Prior Auth Specialist

BH Insurance/Precert Specialist

Prior Authorization Specialist

Utilization Management Specialist

Referral Specialist

Referral Specialist

Customer Account Specialist

Client Insurance Specialist

Customer Support Specialist

Central Pharmacy Liaison

Dental Coordinator

Dental Claims Specialist

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