Prior Authorization Specialist

Prior Authorization Specialist

Konza Prairie Community Health Center is seeking a highly motivated Prior Authorization Specialist to join our team. This position plays a vital role in coordinating patient care by managing all aspects of prior authorizations, referrals, and medical record correspondence to ensure accuracy, timeliness, and continuity of care.

Essential Job Functions

1. Collaborate with third parties (insurance companies, hospitals, imaging facilities) to obtain prior authorizations and schedule patient medical services.
2. Process, maintain, and close prior authorization requests.
3. Follow up with specialty provider offices and close referral loops upon receipt of consult notes or results.
4. Categorize and assign incoming lab and diagnostic imaging results to the appropriate provider.
5. Manage refill requests from outside pharmacies and ensure accurate communication with providers.
6. Maintain third-party portals for shared medical records to ensure prompt referral closure.
7. Prioritize and process referrals based on urgency or provider request.
8. Complete prior authorizations for outbound referrals and diagnostic imaging.
9. Sort, file, and manage medical records (admission slips, lab/pathology reports, operative notes, clinic notes, discharge summaries) ensuring proper sequencing and compliance.
10. Retrieve and track missing medical records as needed.
11. Review records for completeness and follow up on missing documentation.
12. Manage incoming faxes by categorizing, distributing, and attaching documents to the correct records.
13. Participate in quality improvement activities and other duties as assigned.

Requirements

1. High school diploma or GED required.
2. Minimum 1 year of experience with electronic medical records required.
3. At least 2 years of face-to-face experience with medical patients preferred.
4. At least 4 years of customer service experience preferred.
5. Knowledge of healthcare payment methodologies, including Medicare, Medicaid, HMOs, PPOs, and secondary payers, preferred.
6. Minimum 1 year of experience in a family practice or hospital setting preferred.
7. Completion of a certified medical office training course preferred.

Join our team and be part of a supportive, patient-focused environment that values professional growth and collaboration. We offer competitive benefits and opportunities for ongoing development in the healthcare field Here's what you can expect:

• Medical, Dental, and Vision Coverage: Take advantage of our robust health plans to ensure you and your family's well-being.
• Paid Time Off (PTO): Generous PTO accrual of up to 7.71 hours per pay period for a healthy work-life balance.
• 403(b) Retirement Plan with Employer Match: Secure your financial future with our retirement savings plan, complemented by employer contributions.
• Employee Discounts: Insured employees can enjoy exclusive discounts when utilizing Konza's in-house medical, dental, and pharmacy services.
• Early Friday Closure: Konza clinics close at 2:00 pm every Friday, allowing you to kick off your weekend early.

At Konza, we are committed to fostering a workplace that values the contributions of every individual. We believe in the power of different perspectives, backgrounds, and experiences to drive innovation and success. We are an Equal Opportunity Employer, and all qualified applicants will be considered without discrimination.