drjobs Prior Authorization Specialist

Prior Authorization Specialist

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1 Vacancy
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Job Location drjobs

Crookston, MN - USA

Monthly Salary drjobs

$ 20 - 28

Vacancy

1 Vacancy

Job Description

Overview

RiverView Health is a community owned membership based non-profit organization that was formed in 1898 and continues to be the sole community hospital in Crookston MN.

RiverView Health operates a 25 bed Critical Access Hospital RiverView Recovery Center; a chemical dependency outpatient treatment program RiverView Home Care and five primary care and specialty clinics in the hospitals service area.

We have a robust scholarship program for those furthering their education in a medical field excellent benefits and a friendly work environment. Full-time benefits include health insurance free single vision and basic dental insurance life insurance long-term disability and short-term disability and employer HSA contributions. Other benefits include employer pension matching shift differential incentive/premium pay free annual biometric screening and paid volunteer time off.

RiverView is an Equal Employment Opportunity employer.

Responsibilities

Full-time - Prior Authorization Specialist

Location: Hospital - on site

Position Status: 1fte (80 hours per pay-period) - Non-Exempt subject to over-time

Schedule: 80 hours per pay period

Pay Range: $20.53 - $28.74 (based on experience) - benefitted position.

RiverView Health has an opening for a Full-Time - Prior Authorization Specialist who is responsible for securing timely and accurate prior authorizations for medical services procedures medications and equipment. This role ensures compliance with payer requirements and supports efficient patient care delivery by minimizing delays due to authorization issues.

  • Verifies patients demographic insurance and benefits information
  • Obtains pre-authorization and pre-certifications from third-party payers in accordance with payer requirements and documents the authorization number and period of validity in the EMR system (EPIC)
  • Gathers additional medical records from other providers as needed to support medical necessity when obtaining a pre-authorization and follows up with payers on pre-authorization requests as needed
  • Alerts the clinicians involved in the patients care when there are issues with referrals or complications with insurance coverage
  • Maintains accurate records of authorizations within the EMR system (EPIC)
  • Identifies patients who will need to received Medicare Advance Beneficiary Notices of Noncoverage (ABNs)
  • Refers accounts to financial counseling as needed if authorization is not obtained
  • Works with business office staff to support appeal efforts for authorization-related denials
  • Complies with HIPAA regulations as well as the organizations policies and procedures regarding patient privacy and confidentiality
  • Maintains professional tone at all times when communicating with patients and payer representatives
  • Performs other duties as requested

Qualifications

Education/Certifications/Licenses/Experience:

Required:

  • High school diploma or equivalent (GED) required
  • 1 year related working experience in healthcare

Preferred:

  • Associates degree in healthcare or business administration and/or related/comparable experience preferred
  • Certification in medical billing/coding (e.g. CPC CPAR or CHAA)
  • 2 years medical billing experience

Required Experience:

Unclear Seniority

Employment Type

Unclear

Company Industry

About Company

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