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Prior Authorization Specialist Jobs
Company | Sheridan Memorial Hospital |
Address | , Sheridan, 82801, Wy |
Employment type | FULL_TIME |
Salary | |
Expires | 2023-07-29 |
Posted at | 11 months ago |
ABOUT SHERIDAN MEMORIAL HOSPITAL
JOB SUMMARY:
Service excellence and a culture of kindness are priorities for Sheridan Memorial Hospital and must be maintained while providing personalized attention in a professional manner recognizing individual needs and concerns. The duties required include pre-authorization of services performed within the hospital and clinics per payor guidelines in timely manner.
ESSENTIAL JOB FUNCTIONS:
- Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.
- Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.
- Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections.
- Helps to maintain a professional atmosphere for patients, family members and staff.
- Verifies physician orders are accurate, determines CPT, HCPCS and ICD-10 codes for proper Prior Authorization.
- Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.
- Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.
- Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.
POSITION QUALIFICATIONS
Education / Experience / License and Certifications
- High school graduate or equivalent.
- Medical terminology required.
- Knowledge of CPT, HCPCS, and ICD-10 codes preferred.
Additional Skills
- Proficient with the EMR system.
- Ability to interpret a variety of instructions furnished in written, oral, or scheduled form.Proficient with MS Office Suite including Word, Excel and Power Point.
- Ability to cope with stressful situations and maintain a calm and professional demeanor.
- Ability to write clearly and informatively.
- Must possess excellent time management and organization skills with attention to detail.
- Ability to solve conflict.
- Demonstrates the ability to maintain confidentiality.
- Ability to effectively present information and respond to questions from providers, clinical staff, payors, and patients.
- Ability to prioritize and perform multiple tasks with many interruptions.
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Ability to read, analyzes, interprets, and communicate effectively in English.
- Demonstrates critical thinking, creativity, and problem solving.
In accordance with Sheridan Memorial Hospital’s (SMH) duty to maintain a safe work environment for staff, patients and visitors, and to ensure the facility remains in compliance with the Center for Medicare and Medicaid Services (CMS) Conditions of Participation, COVID-19 vaccinations or an approved medical or religious exemption is required in accordance with established CMS requirements.
Specific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products.
Pre-employment drug and alcohol screening is required.
Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights as an applicant under the law, please click here.
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