Job Description

Prior Authorization Specialist

Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs.

As an Authorization Specialist at Cayuga Medical Associates, you are responsible for reviewing physician orders, pharmacy documents and third-party technology platforms to ensure all aspects of the authorization process have been met. The position will be responsible for Initiating authorizations, conducting follow ups, and documenting pertinent information into appropriate systems to ensure patients are clear to receive their medications. The position requires integral communication with clinics, physicians, insurance companies, department administrators, and other departmental staff to ensure the ideal patient experience.

Job Responsibilities:

• Initiate prior authorizations through fax or 3rd party sites.
• Perform follow ups with insurance companies and obtain updates. Submit any additional information needed to ensure approval.
• Validate insurance coverage and benefits.
• Efficiently and accurately gathers and inputs patient/guarantor demographic and financial information.
• Successfully adhere to financial policies and processes, act with integrity, good judgment, take initiative and pro-actively solve problems
• Exhibits competency in the use of all registration systems, electronic verification tools and Web based resources.
• Demonstrates a basic knowledge of third-party reimbursement requirements and regulations.
• Demonstrates a positive and professional approach and communicates effectively with customers and team members at all times.
• Consistently meets quality standards set by Revenue Cycle.
• Meets departmental goals regarding collections, productivity and customer service.
• Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental needs.
• Meets federal, state and hospital requirements related to compliance issues.
• Attends and participates in department staff meetings and attends other meetings as assigned
• Other job-specific duties as assigned

Education Requirements:

• Associate's degree (and two (2) year of relevant experience)
• In lieu of an associate's degree, a HS diploma (or equivalent) with four (4) years of relevant experience

Experience:

• Two (2) years' experience of healthcare experience working for a health plan, physician practice, surgery center or hospital in a business capacity required.
• Experience using Microsoft Office suite including Word and Excel.
• A minimum of one (1) year minimum experience in obtaining authorization with a healthcare provider or insurance company required, data processing, hospital registration, insurance verification
• Knowledge in Medical terminology, to include CPT/Diagnosis codes a MUST

Physical Requirements:

Lifting up to 20 pounds, standing or sitting for extended periods of time, as well as repetitive use of hands and fingers.

Location and Travel Requirements:

• Onsite -16 Brentwood Dr, Ithaca
• M-F

Pay Range Disclosure:

• $20.50 - $26 per hour

Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.

We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.

If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at talentacquisition@cayugahealth.org.

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