Company Description: Community Health Programs is a network of health centers and caring professionals that provide outstanding primary and preventive care for patients of all ages. What’s truly unique to CHP is our broad spectrum of support services that extend beyond medical and dental issues to strengthen families and improve children’s well-being. The region is a federally designated rural community and a Medically Underserved Population Area.
Community Health Programs embraces its role as a nonprofit health care provider and community partner. We are a leader in the communities we serve by providing high quality healthcare, dental services, wellness education and family support services. CHP outreach provides free health screenings, insurance enrollment assistance as well as information so people can learn how to take better care of themselves and their families.
Prior Authorization Representative
Full / Part Time
Medical Assistant Certification - Preference: Preferred
CHP is seeking a Prior Authorization Representative who will be required to obtain prior authorizations for services performed by our providers. Promotes/supports quality effectiveness of Healthcare Services.
• Efficiently obtain all authorizations for procedures to be performed prior to patients scheduled date of service.
• Notify scheduling staff of delays in obtaining these authorizations.
• Inform supervisor about any changes or patterns they are seeing in denials of procedures.
• Accept, handle, and process incoming patient telephone inquiries using appropriate customer service skills, clarify and validate patient inquiries, questions or complaints and correct and update patient account information in the computer system.
• Handle and process incoming patient correspondence. Correct or resolve issue, if possible.
• Provides clear explanations of appropriate patient-related policies.
• Maintains patient confidentiality in accordance with established policies.
• All other duties as assigned.
• High School Diploma – Medical Assistant certification desirable
• At least one year of experience with the insurance authorization process. Experience with medical terminology required.
• Strong organizational, judgment, communication and analytical skills.
• Ability to multi-task and perform multiple priorities.
• Cooperative and professional behavior toward patients, peers, providers, management and visitors.
• Ability to promote favorable image with patients, providers, insurance companies and general public.
• Ability to make decisions and solve problems.
• The ability to contribute in a team environment and/or independently, to provide excellent customer service.
• Working knowledge of Microsoft Office and Athena desired
• Maintains confidentiality;
• Keeps emotions under control.
• Professional, welcoming personality.
• Contributes to building a positive team spirit.
Oral and Written Communication:
• Responds well to questions.
• Takes careful and accurate notes.
• Follows up on messages and ensures delivery of messages.
• Composes/types letters if requested by administration.