Job Description

Prior Authorization Specialist - Clinical

A Prior Authorization Specialist is responsible for maintaining a high level of customer service. They are responsible for ensuring all services for Madison Medical Affiliates have appropriate insurance benefit coverage. This is done by obtaining authorization and confirming notifications are in place prior to all inpatient and outpatient scheduled services within contractual guidelines for elective, urgent, and emergent services. The Prior Authorization Specialist will be processing referrals and scheduled procedures, and initiating contact with insurance carriers to get CPT code approval. This position will perform other duties as assigned in relation to insurance carriers and registration. This role reports to the Supervisor of Informatics and has potential to be remote once trained. 

What You'll Do:

• To obtain required authorization/pre-certifications and second opinion (peer-to-peer) approvals for both in and out-patient procedures.
• Data entry into Epic; updating and correcting patient demographics and insurance when necessary, entering auth approvals and denials.
• Notify physicians and patients of coverage decisions accordingly; forwarding reference numbers and approvals to appropriate personnel.
• Use knowledge resources effectively and stay up-to-date with coding requirements, insurance requirements, and prioritization of dates of service. 
• May perform additional administrative support responsibilities, including but not limited to registration and benefit checks, depending on specific clinic needs.

Key Qualifications & Characteristics

• High School Diploma or equivalent.
• CNA, RN, or any clinical background required
• Minimum of one year experience in a hospital or clinical setting, familiar with registration practices, insurance coverages, authorizations, and managed care areas.
• Excellent written and verbal communication skills, computer skills, independent organizational and prioritization skills.
• Demonstrated ability to work with confidential information.

Perks & Benefits of Madison Medical:

• Competitive PTO plan
• Health insurance, vision, & dental
• 401K employer contribution
• Life Insurance and voluntary disability insurance 
• Monday through Friday clinic hours, no weekends, no holidays
• Opportunity to be a part of Milwaukee's Premier medical practice

Madison Medical is a thriving independent practice serving downtown Milwaukee and all throughout southeast Wisconsin. Made up of over 55 Board - certified physicians, many of whom have reviewed Milwaukee Top Doctors awards year after year, we are dedicated to providing excellent patient care. We are a local organization that cares for having present and accessible leaders, building teams and relationships, and serving our communities. Apply to join our team today!

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