Description The Prior Authorization Specialist is responsible for obtaining prior authorization for procedures and medications. This is a full-time position working Monday - Friday, 8:30 am - 5:00 pm out of our Edina clinic. A $2,000.00 sign-on bonus that will be paid out in 3 increments, starting with $500.00 to be paid out on the pay period after completing 3 months, $500.00 to be paid out on the pay period after completing 6 months, and $1,000.00 to be paid out on the pay period after completing 12 months of employment. Internal applicants are not eligible for sign-on bonus. Colon & Rectal Surgery Associates is an operating division of Infinite Health Collaborative (i-Health), a group of local medical practices, owned and led by its physicians, on a mission to give patients more control over their healthcare. We have a comprehensive Medical, Dental & Vision Plan, Maternity Bundle, 401K with Profit Sharing, Tuition Reimbursement, Gym & Car Rental Discounts and more. Essential Functions: Coordinates and processes medical prior authorizations for pharmaceutical/procedures by reviewing insurance and submitting information needed for coverage. Able to triage incoming calls and requests form provider groups/patient for authorization of services, questions, status updates. Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries. Maintain a working knowledge of health care plan requirements and health plan networks. Verify and document insurance information as defined by current business practices. Research denials, rejections and/or excessive reductions Make outbound phone calls to patients or insurance companies as follow up to unpaid, denied or rejected medication authorizations and document according to current policy. Take inbound calls from patients or insurance companies as follow up to unpaid, denied or rejected medication authorizations and document according to current policy. Any and all other duties as assigned. Education and Experience Requirements: High School diploma/GED or equivalent Customer service experience Previous experience in a healthcare facility in relation to accounts receivable or billing practices preferred. Medicare experience strongly preferred. Insurance knowledge in commercial, work comp, and government payers required Essential Requirements: Ability to: Comply with company policies, procedures, practices, and business ethics guidelines. Complete job required training. Comply with all applicable laws and regulations, (e.g., HIPAA, Stark, OSHA, employment laws, etc.) Demonstrate prompt and reliable attendance. Work in the clinic as well from home. Travel independently throughout the clinic, office, or surgery center (which may include movement from floor to floor); frequent bending, lifting, standing, stooping or sitting for long periods of time may be required. Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines. Communicate and interact in a respectful and professional manner. Prioritize workload while being flexible to meet the expectations of the daily operations. Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions. Understand and execute a variety of instructions. Effectively operate equipment and communicate on and operate the phone system. Work independently with minimal supervision Travel to other work locations, if required Performance Expectations - i-Health's Core Values: Integrity - Do the right thing and take responsibility for what you do and say. Service - Consistently contribute to deliver an exceptional experience. Quality - Act with high purpose, committed effort, and skillful execution to exceed expectations. Innovation - Identify progressive solutions that improve service, teamwork, efficiency, and/or effectiveness. Teamwork - Be a part of the whole; support each ot er positively. Environmental Conditions: Clinic setting/Work from home Notes Infinite Health Collaborative (i-Health) is an Equal Opportunity/Affirmative Action Employer and will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990. This position description will be reviewed periodically as duties and responsibilities change with business necessity. Essential and Additional Job Functions are subject to modification. Infinite Health Collaborative (i-Health) is an Equal Employment/Affirmative Action employer and will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and the ADA Amendments Act of 2008.