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Prior Authorization Specialist - Multi-Specialty Clinic

Job Overview

Prior Authorization Specialist

Position is for the Multi-Specialty Clinic location

Grand River Medical Group is seeking a Prior Authorization Specialist to work in our Multi-Specialty Clinic. As a Prior Authorization Specialist, you will be responsible for obtaining prior authorization approvals for various procedures and services including but not limited to medical, elective, ancillary, and pharmaceutical. You will work closely with insurance companies and health plans to obtain prior authorizations for patients at Grand River Medical Group.

The ideal candidate would be knowledgeable in CPT and ICD coding, medical terminology, and contracted insurance plans and procedures. They would possess strong computer skills, be detail oriented, and self motivated. You will be responsible for prioritizing your workload and being able to multi-task while continuing to provide an exceptional patient experience.

This is a full-time position, 36-40 hours per week. This position has the ability to work from home after the introductory period, with no evening or weekend requirements.

Duties include but are not limited to:

• Initiate prior authorization process by processing clinical requests requiring medical review of the patient's electronic chart.
• Review prior authorization requests and communicate with the healthcare team when additional information is needed.
• Contact appropriate insurance carrier to obtain prior authorization approval number.
• Record prior authorization numbers and information in the patient's electronic medical record.
• Notify appropriate healthcare team when a prior authorization request is denied or a peer to peer review is necessary.
• Handle all requests for prior authorizations in a timely and accurate manner.
• Maintain a thorough understanding of authorization requirements and health plan contracts.

Education/Experience/Skills:

• High school diploma or general education degree (GED) required.
• Minimum of two to three years of similar experience; or equivalent combination of education and experience.
• Knowledge of CPT and ICD coding and medical terminology.
• Knowledge of contracted insurance plans and procedures.

We offer: A competitive hourly wage plus a very attractive benefits package including vacation, generous company provided benefits, and much more.

Grand River Medical Group is an independent physician owned practice located in Dubuque, IA. We provide a wide range of healthcare services from primary care to subspecialty care for adults and children. We currently employ over 300 team members who help support the practices and clinical operations of over 65 physicians, nurse practitioners and physician assistant clinics, our urgent care network, and four dialysis units located in Iowa (Manchester and Dubuque) and Wisconsin (Platteville and Richland Center).

Grand River Medical Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, religion, color, national origin, sex, age, sexual orientation, gender identity or expression, status as a protected veteran, or status as a qualified individual with disability.