Job Description

Kings View is a nonprofit leader in providing behavioral health services to the underserved community, is currently seeking a driven Prior Authorization Specialist to join our mission to provide compassionate services to those with limited resources. Our ideal candidate will have a passion to promote social justice and societal awareness, respect for human dignity, and lead with integrity while listening and responding to the community in need. Prior Authorization Specialist (259) Remote to CA Residents Only The Prior Authorization Specialist is responsible for obtaining prior authorization approvals for medical services, treatments, and medications on behalf of patients. This role ensures that healthcare providers comply with insurance company requirements and that patients receive the necessary care in a timely manner. The specialist will work closely with healthcare providers, insurance companies, and patients to navigate the prior authorization process and resolve any issues that may arise. How will I contribute Create, Review, Evaluate, and Track prior authorization requests for medical services and procedures. Maintain accurate records of all prior authorization requests and decisions in the medical records system. Confirm patient insurance coverage and eligibility, ensuring alignment with requested services. Verify patient eligibility and benefits with insurance providers. Address any issues or delays in obtaining authorizations, escalating complex cases as needed to management or appropriate departments. Assist in generating reports to track authorization trends, approval/denial rates, and turnaround times. Act as a liaison between healthcare providers, patients, and insurance companies to resolve issues related to authorization requests. Research and compile documentation to appeal denied claims or authorizations as necessary. Ensure compliance with all relevant regulations and policies regarding prior authorizations. Stay updated on changes in insurance policies, coding practices, and relevant regulations. Collaborate with clinical staff to address any issues related to patient care and authorization Perform other duties as assigned to support the overall functioning and success of the program. What I bring High School Diploma (or Equivalent) 2 years experience with managed care plans, insurance authorization processes, verification of benefits. Experience in roles such as medical billing, medical coding, insurance verification, or claims processing is highly beneficial. Class C Driving License Knowledge of insurance policies, healthcare/medical terminology, and the prior authorization process. Knowledge of HIPAA and other healthcare-related privacy regulations. Excellent written and verbal communication skills. Detail-oriented with the ability to manage multiple tasks simultaneously and prioritize effectively. Strong problem-solving skills and the ability to work independently and as part of a team. Proficiency in using healthcare management software and Microsoft Office Suite (Word, Excel, Outlook). Proactivity, empathy in communicating with patients, and the ability to work effectively both independently and as part of a team are essential. Healthcare-related degrees or certification (e.g., medical billing and coding, healthcare administration) is preferred. Previous experience in a healthcare setting, particularly in prior authorization, medical billing, or insurance verification, is highly desirable. The Benefits Medical, Dental, Vision Insurance Life and Long-Term Disability Insurance 401k plan Vacation time Twelve (12) Paid Holidays Education Reimbursement Program up to $1000 per year Referral Program Employee Assistance Program An environment of like-minded people reaching for the same goal Serving the underserved community A sense of purpose Who We Are Since 1951, Kings View leads the community in providing behavioral health services to the underserved population. We have a strong tradition of commitment, and we focus on serving rural communities where health resources are often limited. Our people treat the community with care and compassion. We stand by our cornerstone and philosophy of valuing each persons worth, dignity and wholeness in body, mind, and spirit. Our principal core values echo throughout the organization and into our patient-focused programs. At Kings View we are dedicated to continuing our demonstration in the unparalleled commitment to wellness and recovery within each community we serve. Join us and apply today.

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