About this opportunity
Sheridan Memorial Hospital lists this Prior Authorization Specialist opportunity in sheridan, Wyoming. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Medication / Procedure Prior Authorization SpecialistThe Medication / Procedure Prior Authorization Specialist is a health care professional working to validate the patients# health care benefits and obtain authorization for scheduled medications and potentially urgently needed office procedures. Responsibilities include contacting a patient#s insurance company to verify coverage, initiate authorizations, provide clinical documentation, and follow up on previously initiated authorizations. Serves as a valued member of the health care team, helping patients get the medical procedures they need. Also, responsible for responding to telephone/email inquiries from callers as they relate to health services our customers provide.Essential Job Functions:Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented appropriately in the system.Verifies physician orders are accurate, determines CPT, HCPCS and ICD-10 codes for proper Prior Authorization.Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out-of-pocket expenses for point of service collections.Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.Helps to maintain a professional atmosphere for patients, family members and staff.Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.Ability to demonstrate good customer service (AIDET) Aid team members in maintaining turnaround times as expected from client Account for internal control responsibilities in line with the organization#s objectives Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA) Other duties as assigned by supervisor or manager Answer questions and offer other information, as requested, to provide patient-focused service and a positive impression of the organization Suggests improvements and participates in organized efforts to improve service levelsPosition Qualifications:Education / Experience / License and Certifications:High school graduate or equivalent. Knowledge of CPT, HCPCS, and ICD-10 codes preferred. Medical terminology required.3-5 years of experience working in a hospital, doctor#s office, or billing settingHave working knowledge of CPT codes and Diagnostic Codes1-2 years procedure and/or medication authorization experience required.Additional Skills:Ability to effectively present information and respond to questions from providers, clinical staff, payors, and patients.Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.Ability to interpret a variety of instructions furnished in written, oral, or scheduled form.Proficient with MS Office Suite including Word, Excel and PowerPoint.Proficient with the EMR system.Ability to solve conflict.Must possess excellent time management and organization skills with attention to detail.Demonstrates critical thinking, creativity, and problem-solving.Demonstrates the ability to maintain confidentiality.Ability to write clearly and informatively.Ability to cope with stressful situations and maintain a calm and professional demeanor.Ability to exercise good judgment to handle situations appropriatelyAbility to use online resources to and tools to achieve goals in the most efficient mannerAbility to multi-task using several systems and multiple monitors at the same timeSpecific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products.Pre-employment drug and alcohol screening is required.Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status.
Worksite address
sheridan, WY, 82801, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.