Job description

Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who see it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia and Westchester County. Sun River Health is currently seeking a full-time Authorization Specialist to join our Solutions 4 Community Health team.

****** $1500 Sign On Bonus- Terms and Conditions Apply****

Responsible for screening request for prior-authorization. Adheres to policies and procedures in order to comply with performance and compliance standards and to ensure cost effective and appropriate healthcare delivery. Obtains Authorizations under the supervision of the Director of Managed Care and the VP of Managed Care according to departmental guidelines. Per standard workflows, forwards specified requests to the managed care company for review and processing.

Essential Duties and Responsibilities for a Authorization Specialist:

• Verifies member eligibility via epaces and enters information in Managed Care repository.
• Coordinates resolution of escalated member or provider inquiries as related to Prior Authorization.
• Clerical task will include but are not limited to data entry, faxing, filing, copying, scanning and report distribution.
• Processes incoming requests, including authorizing specified services, as outlined in departmental policies, procedures, and workflow guidelines.
• Supports managed care group in following up on request for Authorization or denial notifications.
• Tactfully handle telephone communications with staff, and outside Manage Care Organizations
• Refers any managed care requests that need additional clinical information to Primary Care Program Director.
• Informs care provider and Managed Care Department of authorization decisions made by managed care plan per department procedures.
• Works with members, providers and key departments to promote an understanding of Prior Authorization requirements and processes.
• Prioritizes incoming Prior Authorization requests.
• Identifies and informs managed care department and care providers of any insurance service changes and or benefits available to member.

Minimum Education Requirement: Associate's Degree required

Minimum Work Related Experience: 2-4 years

Sun River Health is a network of over 40 Federally Qualified Health Centers (FQHCs) providing primary, dental, pediatric, OB-GYN, and behavioral health care to over 245,000 patients annually. With a dedicated staff of 2,000 doctors, nurses, and health care professionals, we pride ourselves on delivering high-quality, affordable care to those who need it most. Sun River Health started in 1975 when four African American mothers spearheaded efforts to open our first health center in Peekskill, New York to deliver accessible, high-quality, affordable services to patients in need no matter their race, religion, income, or insurance status. Today, after 45 years of service, Sun River Health is still delivering on that promise to communities across the Hudson Valley, New York City, and Long Island.

Job Type: Full-time

Pay: From $17.25 per hour

Benefits:

• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Remote: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Sun River Health requires COVID Vaccination.

Education:

• Associate (Required)

Work Location: Remote

blackflymedia.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, blackflymedia.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, blackflymedia.com is the ideal place to find your next job.