Prior Authorization Specialist

JOB SUMMARY: This position will be requesting prior authorizations for services provided at MAHEC and services referred outside of MAHEC Service Lines.

SPECIFIC RESPONSIBILITIES:

• This position will be responsible for obtaining and requesting prior authorizations for the following: In-house procedures, Medicare HMO visits, radiology, and behavioral health.
• This position will partner with the clinics and referrals team to acquire the necessary prior authorizations.
• This will include ensuring authorizations are approved and working on any denials that are received. 
• This position will assist with any Peer-to-Peer requests and Appeals that are received.
• This position may also support other areas needing prior authorizations and referrals.

KEY COMPETENCIES:

• Communication Skills

Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families.

• Decision Making

Ability to make the most appropriate decision in each situation and then take the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.

• HealthCare Knowledge

Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate.  This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC’s organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.

• Interpersonal Skills

Showing the ability to meet difficult situations with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when it’s most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others.

• Organizational Values

Adherence to MAHEC’s founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and equitable practices, ability to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need.

• Problem Solving

Having an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically through a difficult problem and come to an appropriate resolution for a given issue. This helps to drive continuous improvement by thinking through where we can improve in a novel way. Measures success by understanding where we are currently and where we want to go and then applying those new ideas to affect positive change.

SPECIFIED SKILLS

• Computer            Basic typing, Microsoft Office Suite, (Outlook, Excel, Word, PPT), Data                       Entry Required. Allscripts EHR experience preferred.

• Foreign Language

                                    Fluency in Spanish a plus.

PHYSICAL DEMANDS

Typical fast-paced office environment with computers, monitors, printers, email, patient and provider messages in EHR system, phone calls. Sitting for prolonged periods of time.

SUPERVISORY RESPONSIBILITIES:

• Not Applicable.

EDUCATION AND EXPERIENCE

MINIMUM QUALIFICATIONS:

• Some college and/or equivalent experience in the healthcare field such as Prior Authorization Experience, experience in Human Services or Healthcare Administration, with a focus on Utilization Review.

PREFERRED QUALIFICATIONS:

• Previous experience in prior authorizations is preferred  

SCHEDULE:

• Regular attendance on-site is an essential function of this position. Typical business hours are Monday – Friday, 8:00 am to 5:00 pm (or flexed to best meet the needs of the clients and/or the Division); 40 hours per workweek; weekend, holiday, or evening coverage is occasionally required. Work hours will need to be flexible to respond to special work assignments, or evening activities, as requested by the team leader.

At MAHEC, we strive to equip all team members with Total Rewards (pay + benefits) to honor their service, support their health, manage their financial security, build their career, and thrive.

MAHEC is a qualifying employer for the Public Service Loan Forgiveness (PSLF) Program. Employees who meet federal requirements may be eligible to have remaining student loan balances forgiven after 10 years of qualifying payments while working full-time at MAHEC.

If you are interested in this role, and you have related experience and qualifications, we encourage you to apply or reach out to [email protected] for support in your job search process. You could be the talent we are seeking for this or other opportunities

All MAHEC employees and learners will be required to receive the Flu vaccine or have an approved exemption.

MAHEC does not provide employment-based US visa sponsorship, now or in the future. All new employees must provide valid, original I-9 documents on their first day of work.

MAHEC Talent Management is located at 121 Hendersonville Road, Asheville, NC 28803. Equal Opportunity Employer.