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Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance
Under the supervision of the Business Services Supervisor, the Prior Authorization Specialist (PAS) is responsible for processing incoming referral requests to obtain prior authorizations from health plans, document and complete incoming referral requests, timely, accurately and efficiently and to communicate referral outcomes with internal and external customers, as needed. The PAS will accurately verify and document in the practice management system all pertinent information conducive to proper claim adjudication by the health plan. The PAS initiates communication with the clinic/physician when a referral is denied and/or requires additional information, Peer to Peer Review, etc. The PAR will be logging in to the designated phone queue to answer, direct and/or resolve any inquiries or directions regarding referrals. Additional duties include handling and appropriately directing referral status requests as needed.
Prior Authorization Specialist
Location: Pearland Administrative Office
Department: Central Business Office
Job Type: Full Time
Salary Range: $37,668.80 to $46,529.60 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Required: High School diploma or GED from an accredited institution
Preferred: College level courses
Required: 2 years of medical office experience either in a physician office or hospital setting, health plan, ACO, or other managed care setting. Experience navigating payor web portals.
Preferred: Knowledge of CPT & ICD 10 Coding methodologies. Prior experience with precertification and/or utilization management.
Preferred: Epic System usage.
Required: Working knowledge of medical terminology and HMO/ PPO authorization processes. Excellent communication skills. Alpha/numeric data entry and basic PC Literacy. Good problem-solving skills. Ability to handle a variety of tasks with speed, attention to detail and accuracy.
Required: Excellent time management skills to handle high workload volume. Self-directed, attention to detail. Excellent interpersonal communications skills with ability to communicate effectively both orally and in writing with patients, physicians, management, and third-party representatives. Ability to empathize with patients in need of care.
Working Environment: Office Setting