United States onlyPosition Summary:
The purpose of the Prior Authorization Technician is to work cooperatively with licensed clinical staff to provide patients and physicians with accurate and timely determination of the prior authorization requests based on clinical guidelines. The Prior Authorization Technician will assist in maintaining compliance of the prior authorization processes and turnaround time requirements.
Position Reports to:
- This position reports to the Director of Operations and requires minimal degree of supervision to ensure tasks are appropriately prioritized.
Job Duties and Essential Functions:
- Responsible for providing timely referral determination by accurate:
- Usage of the Milliman Care Guidelines
- Identification of referrals to the medical director for review
- Appropriate letter language and coding (denials, deferrals, modifications)
- Appropriate selection of the preferred and contracted providers
- Proper identification of eligibility and health plan benefits
- Proper coding to trigger the record to be routed to a different work queue or to trigger the proper determination notice to be sent out
- Responsible for maintaining compliance in turn around time requirements as mandated by the ICE TAT Standards
- Continuous monitoring of the pended documents
- Responsible for working closely with supervisor/lead to address issues and delays that can cause a failure to meet or maintain compliance.
- Responsible for maintaining the performance standard of one ninety (60) status 1, 2, 3, referrals per day.
- Responsible for processing OB deliveries by entering the following information in Ezcap:
- Admit date
- Discharge Date
- Type of delivery (vaginal or c-section)
- Appropriate Milliman Care guidelines
- Case Summary
- Attends all mandatory trainings
- Maintains and keeps in total confidence, all files, documents and records that pertain to the operation of business of Cap Management Systems.
- All other job related duties as it relates to the job function or as delegated by the management team.
Physical Requirements:
- Light physical effort (lift up to 10lbs).
- Mostly sedentary work.
- Regularly needs to be able to bend, stoop and reach to file.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Educational Requirements:
- Bachelor’s Degree preferred or equivalent experience
- Medical Coding/Billing Terminology experience
Experience/Skills Requirements:
- Two years managed care experience in Medical Management.
- Computer skills: EZ-CAP, Word 7.0 and Excel required.
Compensation and Benefit Information
Compensation
- Pay: $17.20-$25.70 per hour. Compensation depends on location, qualifications, and experience.
- Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
- Conifer observed holidays receive time and a half.
Benefits
Conifer offers the following benefits, subject to employment status:
- Medical, dental, vision, disability, and life insurance
- Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
- 401k with up to 6% employer match
- 10 paid holidays per year
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
- For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
1. Responsible for providing timely referral determination by accurate:
- a. Usage of the Milliman Care Guidelines
- b. Identification of referrals to the medical director for review
- c. Appropriate letter language and coding (denials, deferrals, modifications)
- d. Appropriate selection of the preferred and contracted providers
- e. Proper identification of eligibility and health plan benefits
- f. Proper coding to trigger the record to be routed to a different work queue or to trigger the proper determination notice to be sent out
2. Responsible for maintaining compliance in turn around time requirements as mandated by the ICE TAT Standards
3. Continuous monitoring of the pended documents
4. Responsible for working closely with supervisor/lead to address issues and delays that can cause a failure to meet or maintain compliance.
5. Responsible for maintaining the performance standard of one ninety (60) status 1, 2, 3, referrals per day.
6. Responsible for processing OB deliveries by entering the following information in Ezcap:
- a. Admit date
- b. Discharge Date
- c. Type of delivery (vaginal or c-section)
- d. Appropriate Milliman Care guidelines
- e. Case Summary
7. Attends all mandatory trainings
8. Maintains and keeps in total confidence, all files, documents and records that pertain to the operation of business of Cap Management Systems.
9. All other job related duties as it relates to the job function or as delegated by the management team.
Light physical effort (lift up to 10lbs). Mostly sedentary work. Regularly needs to be able to bend, stoop and reach to file.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Educational Requirements:
- Bachelor’s Degree preferred or equivalent experience
- Medical Coding/Billing Terminology experience
Experience/Skills Requirements:
- Two years managed care experience in Medical Management.
- Computer skills: EZ-CAP, Word 7.0 and Excel required.
