Prior Authorization Specialist Almara OGI Edina

Edina, MN - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

This is a full-time role Monday - Friday 8:00 AM - 4:30 PM flexible based upon business need out of our Edina location.

Almara Womens Health Obstetrics Gynecology & Infertility is an operating division of Infinite Health Collaborative (i-Health) a group of local medical practices owned and led by its physicians on a mission to give patients more control over their healthcare.

Essential Functions:

Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage
Able to triage incoming calls and requests form provider groups/patient for authorization of services questions status updates
Ensure professional communication with patients clinic personnel and outside vendors whether over the phone via email or other written documentation and respond to all inquiries
Maintain a working knowledge of health care plan requirements and health plan networks
Verify and document insurance information as defined by current business practices
Review Explanation of Benefits (EOB) research denials rejections
Ensure appropriate forms are used when requesting authorizations insurance transfers or other specific account changes
Make outbound phone calls to patients clinical staff partner facilities and insurance companies
Take inbound calls from patients clinical staff partner facilities and insurance companies
Any and all other duties as assigned

Education and Experience Requirements:

High School diploma/GED or equivalent
Customer service experience
Previous experience in a healthcare facility in prior authorization preferred. Medicare experience strongly preferred.
Insurance knowledge in commercial work comp and government payers required

Benefits & Compensation:

Actual starting pay will vary based on education skills and experience.
We offer a comprehensive benefits package - to learn more click
here.
- Employees working 30 hours per week (60 hours per pay period) are eligible for our Medical (w/Maternity Bundle) Dental & Vision plans as well as Tuition Reimbursement.
- All employees regardless of hours are eligible for 401(k) w/ Profit Sharing Employee Assistance Program Lifetime Fitness Subsidy Car Rental discounts Home Auto & Pet insurance savings programs & more.

Working Conditions:

Ability to sit for extended periods (up to 8 or more hours per day).
Frequent use of hands and fingers for typing writing and handling documents.
Occasional standing walking bending or reaching within the office environment.
Ability to lift and carry office supplies or files weighing up to20 pounds.
Visual acuity to read electronic and paper documents.
Auditory ability to participate in phone or video calls clearly.
Manual dexterity to operate standard office equipment (e.g. computer phone printer).

Setting:

Office

Essential Requirements:

Ability to:

Comply with company policies procedures practices and business ethics guidelines.
Comply with all applicable laws and regulations (e.g. HIPAA Stark OSHA employment laws etc.)
Demonstrate prompt and reliable attendance.
Work at an efficient and productive pace handle interruptions appropriately and meet workload effectively.
Communicate respectfully and professionally in face-to-face phone and email interactions. Apply principles of logical thinking to define problems establish facts and draw valid conclusions.

Notes

Revo/ i-Health is an Equal Opportunity Employer. We are committed to fostering an inclusive and accessible workplace. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential job functions. Applicants or employees who wish to request an accommodation may do so by emailing . For more information please review the Know Your Rights notice from the U.S. Equal Employment Opportunity Commission.
We participate in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program please click here: note: This job description is intended to describe the general nature and level of work being performed by individuals assigned to this position. It is not an exhaustive list of all duties responsibilities and qualifications required. Revo/ i-Health reserves the right to modify job duties or descriptions at any time with or without notice in accordance with applicable laws.

Required Experience:

The Prior Authorization Specialist is responsible for efficiently working accounts receivable for the organization while maintaining customer position will focus on obtaining prior authorization for procedures.This is a full-time role Monday - Friday 8:00 AM - 4:30 PM flexible based upon business n...