Prior Authorization Analyst

Job#: 2011436

Job Description:
Job Profile Summary

• This advanced level Pre-certification Coordinator specializes in complex pre-certifications for high dollar oncology and/or non-oncology drugs as indicated on therapy and treatment plans to prevent controllable losses/write offs for the Department.
• This position may also perform rechecks of insurance eligibility and verify authorization information for each service.
• This position will also document all pertinent authorization information in Epic and communicate with clinical staff and providers in a timely and effective manner.

Primary Duties & Responsibilities

• Completes pre-certifications for complex and high dollar drugs as indicated on therapy and treatment plans.
• Must read and analyze therapy and treatment plans, drug protocols and clinical documentation, as well as payer policies and patient benefits.
• Completes the authorization process with the payer and in EPIC. 40%
• Completes rechecks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services. Confirms all recheck information is documented in EPIC. 30%
• Works with clinical staff and providers on add-ons, denials and peer to peers through to resolution in a timely fashion. 20%
• Other duties as assigned, such as assistance with denials, rejections and appeals. 10%.

Preferred Qualifications

• Some college or associates degree; RHIT and/or CPC certification; coding experience and previous precertification experience preferred.
• Applicant must have a thorough understanding of both insurance database and insurance terminology. Critical

Skills & Expertise

• Excellent communication, interpersonal and organizational skills requires; experience interacting with managed care plans, insurance companies and third-party payers; ability to work with internal and external customers, including physicians, nurses, patients and families.
• This person must be able to prioritize multiple tasks, be very details oriented and able to work in a fast paced environment.

Pay Rate - $21/hr

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or .

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.