Prior Auth & Credentialing Specialist at Gothenburg Memorial Hospital

Gothenburg, Nebraska, United States -

Full Time

Start Date

Immediate

Expiry Date

28 May, 26

Salary

0.0

Posted On

27 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior Authorization, Credentialing, Payer Enrollment, Liaison, Contract Negotiation, Payer Matrix Management, Third-Party Credentialing Bodies, Clinical Documentation, Revenue Cycle Management, RHC Guidelines, CAH Guidelines, Insurance Guidelines, HMO/PPO Knowledge, Medicare Knowledge, Medicaid Knowledge

Industry

Hospitals and Health Care

Description

Description Position Summary The Prior Auth & Credentialing Specialist is responsible for maintaining facility and provider enrollment with payers. They will serve as the liaison with 3rd party to provide information and data as needed to maintain and establish enrollment. Responsible for obtaining contracts with the payers for the facility to know payment guidelines. Works with ordering providers to vet prior auth on tests/exams being ordered. This position reports to the Revenue Cycle Director. Key Accountabilities Prepare and obtain contracts for payers to be reviewed by the CFO prior to initiating said contracts. Keep payer matrix spreadsheet up-to-date and current with any changes. Maintain an open communication channel with 3rd-party credentialing bodies and provide information as requested and necessary for payer credentialing processes. Work with providers to vet prior authorizations for tests and exams being ordered, initiate the prior authorization process, and provide necessary clinical documentation as requested by payers for authorization processes. Assist Patient Accounting with answering phones and handling patient billing questions. Minimum Qualifications High school diploma or GED required. Knowledge of RHC and CAH guidelines. Knowledge of insurance guidelines, including HMO/PPO, Medicare, and Medicaid plans. Healthcare experience required. Full-time position, Monday – Friday, 8:00 a.m. – 5:00 p.m. About Gothenburg Health Gothenburg Health is a critical access hospital and clinics located in Gothenburg, Nebraska. This is an opportunity to join an innovative and positive work culture with a growing healthcare provider with unparalleled passion. We offer a competitive salary and benefit package that includes vacation and sick leave, extended illness, health insurance, paid life insurance, paid long-term disability, and a defined contribution retirement plan with an employer match. Apply now online to begin your journey with Gothenburg Health.

Responsibilities

The specialist is responsible for maintaining facility and provider enrollment with payers, serving as a liaison for data exchange, and obtaining payer contracts to understand payment guidelines. They also vet prior authorizations for tests and exams ordered by providers.