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Prior Authorization Specialist Jobs

Company

Logan Health
Address , Kalispell, Mt
Employment type FULL_TIME
Salary
Expires 2023-07-26
Posted at 11 months ago
Job Description
Summary:
This position is responsible for obtaining prior authorizations for all procedural orders by successfully completing the prior authorization process per department procedure and protocol.
Qualifications:
  • Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed. Meditech experience preferred.
  • Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
  • Possess insight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required.
  • Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required.
  • Minimum of two (2) years’ experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required.
  • Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
  • Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
  • Possess a working knowledge and understanding of ICD-9 and CPT codes required.
Job Specific Duties:
  • Informs, educates, and communicates with leadership to include, but may not be limited to; billing or authorization concerns, backlogs, insurance issues, problematic accounts, documentation issues, etc.
  • Responsible for obtaining accurate prior authorizations for facility and professional charges related to scheduled patient appointments per department procedure and protocol.
  • Reviews accuracy and completeness of information requested and ensures all supporting documents are present. Collaborates with stakeholders as appropriate.
  • The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.
  • Accurately secures patients’ demographics and medical information and ensures all procedures are in line with HIPPA compliance and regulations.
  • Maintains the Logan Health intranet related to payer requirements needed to successfully obtain a prior authorization.
  • Performs timely and accurate submission of CPT, HCPCS codes and medical records to insurance carriers to expedite prior authorization requests.
  • Exhibits written and verbal professionalism at all times when interacting with others. Ensures all departmental transactions and interactions are completed with integrity, confidentiality, and professionalism.
  • Contacts patient and/or clinic to advise if authorization request has not been obtained prior to date of service.
  • Prioritizes incoming authorization requests according to department procedure and protocol. Confirms accuracy of CPT and ICD 10 diagnoses in the procedure order.
  • Researches and works with appropriate stakeholders in initiating retro authorization requests and resolving authorization denials as needed. Prepares, submits, and tracks appeals as necessary. Accurately documents patient accounts of all actions taken.
  • Adapts to changing circumstances to meet the needs of patient flow.
Maintains regular and consistent attendance as scheduled by department leadership.
Shift:
Day Shift - 8 Hours (United States of America)
Schedule Details:
Please know schedules and shifts are subject to change based on patient care and department/organizational needs.
Schedule:
Logan Health operates 24 hours per day, seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
Notice of Pre-Employment Screening Requirements
If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:
  • Health and Immunizations Screening
  • Criminal background check
  • Physical Demand Review/Screening
  • Drug Screening
  • Reference checks
Equal Opportunity Employer
Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability or any other basis protected by applicable law. If you require accommodation to complete the application, testing or interview process, please notify Human Resources.