Prior Authorization Coordinator

PHOENIX HEALTH PLAN/COMMUNITY CONNECTION

JOB TITLE:
Prior Authorization Coordinator

DEPARTMENT:
Prior Authorization and Medical Services

REPORTS TO:
Sue Baker, RN, PA Manager and
Ray Percell, PA Supervisor

Summary of Job/Objectives:

This position is responsible for reviewing prior authorization (PA) requests and following the PA process. Individual must build rapport over the telephone and present information in a professional and accurate manner. The representative will be responsible for entering the PA data into the system and preparing requests for higher level review according to departmental policy. Incumbent must follow all company and customer work standards and must meet performance criteria to include assigned goals. Work is performed within clearly defined areas of regulations and procedures, and is reviewed and monitored by a supervisor or manager.

Responsibilities/Functions:

Use multiple computer programs to validate eligibility and provider contract information

Accurately enter prior authorization information into the computer system

Ensure appropriate feedback and follow-up with all prior authorization requests

Collect all pertinent data to forward to Nurse or Medical Director for review

Processes referrals for authorization with time frames set by Regulatory or Company policy

Assist with statistics as assigned

Works with other departments as appropriate

Maintains professionalism at all times

Must be flexible and able to adapt to change

Expand knowledge of different program plans and technology

Excellent organizational skills

Special projects as assigned

We are located on the corner of 16th Street and Northern.
REQUIREMENTS
Knowledge/Skills:

Have excellent organizational, analytical, and communication skills

Good problem solving and decision making ability

Must be able to follow oral and written instructions

Advanced proficiency in Word and experience using Excel

Enjoy working in a fast-paced, production-oriented environment and be able to handle stress

Must be able to manage multiple tasks

Must have the ability to anticipate needs

Must have the ability to maintain high level of confidentiality

Must have excellent attendance

Willing to work hours necessary to successfully accomplish assigned tasks

Needs to consistently meet quality, production and attendance standards

Qualifications:

Incumbent must have at least 1 year of managed care experience

Demonstrated working knowledge of medical terminology

Computer skills including Microsoft office products

Good oral and written skills