Prior Authorization Specialist
ON SITE in Sartell, MN - This is not a remote position.
The Prior-Authorization and Referral Representative contacts insurance companies on behalf of patients to obtain prior authorizations. Serves as a patient advocate and functions as a liaison between the patient and payer to address reimbursement questions and avoid insurance delays. Provides information to support the medical necessity of patient treatments and testing. Communicate with healthcare team members to obtain necessary information as well as to inform them of any special requirements by particular insurance plans. Researches additional or alternative resources for non-covered services to prevent payment denials. Enters and scans information into EMR.
This position is responsible for tracking/correcting all pertinent insurance information into EMR. They are responsible for providing patients with the most accurate data as it pertains to receiving services with Alliance Imaging and Regional Diagnostic Radiology.
Please Note: This role involves comprehensive prior authorization responsibilities beyond basic insurance eligibility verification. Candidates with experience limited to insurance eligibility and verification are not a fit for this position.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Works with insurance companies to make sure that prior authorization and referral requirements are met
- Possesses excellent telephone etiquette, problem-solving, and active listening skills
- Documents and tracks all communication with insurers, providers, and patients
- Documents each step taken in the process of obtaining authorization or confirmation of compensability determination.
- Enters all prior authorization information timely and accurately into EMR referral.
- Informs patients and providers of denials by insurance companies when prior-authorizing services
- Develop a list of key contacts at insurance companies and work to build and maintain positive working relationships with said individuals to authorize claims and maximize reimbursement
- Contact patients to advise them of copays due at the time of service
- Adapts to changes in the volume of workload
EDUCATION AND EXPERIENCE
- High School Diploma
- Insurance Prior-Authorization Reimbursement experience
- High attention to detail
- Experience working with various payors including, Medicare, Medicaid, Private Payors, and Workers' Compensation as it relates to medical procedures, services, and devices
- Able to accurately document and verbalize problems
- Experience building effective relationships with internal and external customers
- Proficient in MS Word, Excel
- Must be self-motivated, a team player
- Must have proven customer satisfaction skills
- Must be able to multi-task
KNOWLEDGE AND SKILLS
This position requires the application and interpretation of insurance policies and procedures and the use of independent judgment in a medical setting. The ability to maintain a working knowledge of carrier contracts/changes and departmental policies and procedures is required.
- Enters appropriate documentation in patient records correctly
- Performs basic eligibility, co-pay, and pre-authorization requirements
- Ability to handle difficult situations and persons in a positive and professional manner
- Applies effective listening techniques
- Requires proficiency with computer programs
- Requires ten-key experience
- Requires strong organizational skills
- Ability to maintain confidentiality
- Maintaining patient confidentiality as per the HIPPA
- Competent use of Imagine billing software or proficiency within 3 months of hire
WORKING AND ENVIRONMENTAL CONDITIONS
Normal Medical Clinic Environment: Indoors in a clean, well-illuminated area of constant temperature in which one is exposed to only noise from business machines and medical practice equipment.
PHYSICAL REQUIREMENTS
- Lifting: 5-50 pounds periodically
- Eye-hand coordination and manual dexterity sufficient for the operation of standard office equipment
- Repetitive movement of digits
- Normal range of hearing and vision
- Ability to speak in a clearly understood manner
- Sitting 90% of the time
- Some bending, stooping, lifting, and stretching
Note: This job description is not intended to be all-inclusive. Employee may perform other related duties as assigned to meet the ongoing needs of the organization.
We offer competitive benefits packages, including medical/dental/vision insurance, paid time off, retirement plans, and opportunities for professional development. If you are ready to make a difference in the lives of patients and contribute to the success of our practice, apply now!
Job Type: Full-time
Pay: $18.00 - $24.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee discount
- Health insurance
- Life insurance
- Paid time off
Experience:
- manual prior auths incl. follow-up & clinical review: 1 year (Required)
Ability to Commute:
- Sartell, MN 56377 (Required)
Work Location: In person
