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Medical Management Outpatient Pre-Auth Specialist

Company: Vantage Health Plan, Inc.
Location: Monroe
Posted on: November 23, 2021

Job Description:

Job Summary: The Medical Management Outpatient Pre-Auth Specialist provides administrative support throughout Vantage's authorization process. This includes answering phone calls to Medical Management, entering specific types of authorizations, performing call-backs for approvals and providing other types of non-clinical support to the Medical Management Department. Essential Duties & Responsibilities: --- Answers incoming phone calls regarding authorization verifications and provides notification of authorization approvals, as indicated --- Provides guidance for non-clinical questions regarding authorizations, such as where to locate the preauthorization form on Vantage's website and assists with provider requests for emailing or faxing the preauthorization form --- Assists with the collection and data entry for pre-authorizations under the supervision of appropriately licensed health professionals. This may include demographic information (e.g. patient's name, date of birth, ordering physician, where services are to be performed, date of service, etc.) Clinical information recorded will be limited to the diagnosis and name of the requested service or procedure --- Approves services based on set criteria where no clinical judgment is required. --- Provides assistance to members and providers regarding Your Hearing Network program. This includes verifying benefits. --- Prepare and mail out Medical Management member surveys on a quarterly basis --- Additional duties as assigned Job Requirements:Knowledge, Skills, and Abilities: --- Must have 1-year experience in a healthcare office setting --- Must have 2 years' experience in business office setting --- Medical Terminology knowledge preferred --- Exceptional organization skills required --- Must possess proven abilities to prioritize and multitask --- Ability to work with supervision and follow established policies and procedures --- Exceptional interpersonal, verbal, and written communication skills --- Customer service-oriented attitude/behavior --- Excellent computer skills, including intricate knowledge of Microsoft Office programs including Excel, Outlook and Word --- Experience in the following preferred: Acuity, QNXT, Vnet, Faxcom --- High School Graduate Supervisory Responsibilities: --- None Supervision Received: --- Works under general supervision of the Medical Management Outpatient RN Coordinators and the occasional supervision of the Director of Medical Management Working Conditions: --- Overtime may be occasionally required Physical Demands The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to satisfactorily perform these essential functions without causing an undue hardship for the employer. While performing the duties of this job, the employee is required to transverse about the clinic constantly and may, on occasion, remain stationary for long periods of time. The employee must regularly communicate with others and is frequently required to operate a computer and other standard medical office equipment. The employee is often required to move up to 20 pounds and is occasionally required to move between 50 and 100 pounds.

Keywords: Vantage Health Plan, Inc., Monroe , Medical Management Outpatient Pre-Auth Specialist, Executive , Monroe, Louisiana

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