PATHS

SUMMARY

The Prior Authorization Specialist (PAS) is responsible for obtaining authorization from insurance carriers for dental services that require prior authorization for all PATHS Dental locations. The PAS will note and scan documents into the electronic health record and communicate the status to clinical staff, front end staff/site manager, patients and the Billing Department.

 

Education and/or experience

Associates degree preferred, minimum 1 year of previous experience working in a dental or clinical office; but will consider combination of education and work experience; previous medical/dental billing and/or pre-authorization experience is a plus. Job has the option to be in office and/or work from home depending on functionality.

Competencies

• Demonstrates strong written and verbal communication skills with the ability to effectively communicate with providers, patients, clinical and administrative staff

• Excellent Customer Service skills

• Solid knowledge of clinic office procedures, dental practice and dental terminology

• Ability to recognize, evaluate and solve problems

• Strong organizational skills and attention to detail

• Proficiency in MS Word, Excel, Outlook

• Knowledge and experience working with an Electronic Medical Records system (preferably eClinicalWorks), dental insurances processes and procedures, NEA FastAttach

• Work independently

• Strong interpersonal skills

• Prioritizing and planning work activities as to use time efficiently

• Dependability, able to follow instructions, respond to direction and able to improve performance through management feedback

• Maintain very strict confidentiality

 

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Contacts appropriate insurance carrier by web, email or over the phone to obtain prior authorization for dental services

• Follows prior authorization procedures to ensure standardization of approval for all health care sites

• Maintains continued authorizations ensuring that all treatment dates are covered for reimbursement

• Notifies patients of their financial responsibility and discuss payment arrangements

• Coordinates and communicates information to providers/clinical staff, patient or Billing Department in a timely manner

• Notifies dental team of approval of prior authorization

• Notifies patient of the prior authorization status and informs them of the cost of dental services, if any

• Performs other related duties as assigned