Prior Authorization Specialist - Full Time - Day Shift at Minidoka Memorial Hospital

Rupert, Idaho, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Jan, 26

Salary

0.0

Posted On

16 Oct, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Service, Communication Skills, Medical Terminology, EHR Utilization, Documentation, Insurance Verification, Teamwork, Self-Motivation, Attention to Detail, Problem Solving, Medical Necessity Determination, Claim Resolution, Fast-Paced Environment, Confidentiality, Initiative, Accuracy

Industry

Hospitals and Health Care

Description

Description Job Summary Oversees the process of incoming patient orders and obtains information necessary to complete the pre-authorization and scheduling of an order. This process includes collecting all the necessary documentation, contacting the referring provider if needed. This position will also be responsible for the completion of the required pre-authorization process for obtaining insurance and Medicare/Medicaid payment approval prior to the scheduling of an order. Duties and Responsibilities · Maintains process for identifying and prioritizing orders for scheduled services requiring pre-authorization. · Reviews documentation from ordering physician to meet the needs of the payee. · Verifies diagnosis code on patient billing is accurate and reimbursable/payable. · Works with patients’ insurance companies to pre-certify/authorize services as ordered by the referring physician. · Communicates with departments as needed to keep them updated. · Communicates with customers to request additional documentation as needed. · Utilizes EHR to document pre-authorization numbers and notes pertaining to acquiring pre-authorization. · Assists with any denied claims to resolve any issues. · Educates and assists departments in medical necessity determinations and collaborating with ordering physician offices for appropriate testing. · Utilizes EHR in automated processes of determining medical necessity of services. · Actively engage in quality improvement activities. · Perform other duties as assigned. Requirements Minimum Requirements · High school diploma or equivalent · Operating knowledge of personal computers and MS Windows applications (including Word, Excel and Outlook) · Proven customer service skills Preferred Requirements · Prior experience with patient scheduling or working in a medical environment · Previous billing, Medicare and private pay experience · Knowledge of CPT, HCPCS and some knowledge of ICD-10 codes · Familiarity with Medical Terminology Skills/Competencies · Able to work in a high volume/fast-paced environment. · Ability to work with sensitive and confidential information. · Must possess superb communication skills. · Must be able to interact with patients, insurers and ordering physicians and their staff in a responsible, professional and ethical manner. · Must be able to function effectively in a team-oriented environment. · Must be self-motivated and able to work independently with limited direction. · Must be reliable and demonstrate sound judgment and initiative. · Possess a high degree of accuracy in work output. Physical Requirements Perceive the nature of sounds by the ear, express or exchange ideas by means of spoken word, perceive characteristics of objects through the eyes, extend arms and hands in any direction, seize, hold, grasp, turn, or otherwise work with hands, pick, pinch, or otherwise work with fingers, perceive such attributes of objects or materials as size, shape, temperature, or texture; and stoop, kneel crouch, and crawl. Must be able to lift 25 pounds maximum with frequent lifting, carrying pushing, and pulling of objects weighing up to 10 pounds. Continuous sitting, walking and standing. Must be able to identify, match, and distinguish colors.

Responsibilities

The Prior Authorization Specialist oversees the process of incoming patient orders, ensuring pre-authorization and scheduling are completed. This includes collecting documentation, contacting providers, and working with insurance companies for payment approval.