Capital Digestive Care (CDC) a GI Physician Practice office located in Chevy Chase, MD has an exciting opportunity for a Full Time Lead Prior Authorization Specialist to join the team!

The schedule for this position is M-F 8:00am-4:30pm.

For more info about our location please visit: www.capitaldigestivecare.com

What makes us awesome:

Perks and benefits offered to eligible employees

· No evening, on-call or holiday work hours

· Paid Time Off - Vacation, Sick, Holidays, Bereavement, Jury, and Voting

· High quality, cost effective Medical, Dental, Vison, and Prescription benefits

What you will be working on:

Responsible for leading a team that provides continued clinical care of our patients by ensuring Capital Digestive Care patients receive medication and /or a plan of treatment that requires pre-authorization from insurance carriers. Individual collects demographic, insurance and clinical information from provider and patient to ensure all reimbursement requirements are met. Closely and properly monitors requests for pre-authorizations. Leads team of 3 other prior auth specialists, follows up on complicated appeals. Must project a professional image supporting our providers in a safe and efficient manner while providing excellent customer service.

Duties/Responsibilities:

· Serve as team lead for infusion prior auth specialists. Is resource for complicated prior authorizations, helps facilitate appeals process, communicates any delays with both patients and ordering providers. Closes loop with clinical and scheduling team once prior authorization is obtained.

· Understand insurance requirements for prior authorization for Capital Digestive Care’s most common payers

· Process referrals and submits medical records to insurance carriers to expedite prior authorization processes

· Manage correspondence with insurance companies, physicians, specialist and patients as required

· Contact payer to obtain authorization. Gather additional clinical and/or coding information, as necessary, to obtain prior authorization. Enter prior authorization information into gGastro to ensure accurate and timely claims filing

· Advise providers, patients and clinical staff when issues arise relating to obtaining prior authorization. If necessary, notify Patient Financial Services of uninsured situations.

· Assist Patient Financial Services department with denials and submitting appeals on the patient’s behalf

· Serve as primary resource to patients regarding prior authorization process. Explain requirements, terminology, billing process, consent requirements, collect insurance information, etc. as necessary

· Participates in quality and process improvement

What you’ll know:

· A successful applicant must be legally authorized to work in the United States without sponsorship.

· High school diploma or GED

· 3 year’s medical office experience, GI experience a plus

· 1 year experience as a prior authorization specialist, leadership experience preferred

· Knowledge of EMR and medical terminology

· Must be a team-player with excellent multi-tasking and interpersonal skills

· Compassion for patient needs and a high degree of professionalism

Mandatory participation in the Coronavirus Disease 2019 (COVID-19) Vaccination program is required for all Center Health Care Personnel (HCP).

Capital Digestive Care (CDC) partners with PE GI Solutions who provides over 600 gastroenterologist partners industry-leading practice and center management solutions across the nation. This includes a comprehensive business approach to compliance, operations, corporate services and clinical support. For more information about our partner, PE GI Solutions, please visit www.pegisolutions.com.

Diversity & Inclusion

We value diversity! Weprovide equal employment opportunities to all employees and applicants without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No weekends

Ability to commute/relocate:

• Chevy Chase, MD 20815: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Medical office: 3 years (Preferred)
• prior authorization: 1 year (Preferred)
• EMR systems: 1 year (Preferred)

Work Location: One location

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