Prior Authorization Rep Sr

JOB DETAILS Department: Financial Securing FTE: 1.00 (80 hours per pay period) Workdays: Monday - Friday Shift(s): Days Shift Length: 8 hours Location: Remote* *reputed company List of non-MN States where reputed company is an Eligible Employer: Alabama, reputed company, Arkansas, Delaware, Florida, reputed company, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Mississippi, Nevada, reputed company Carolina, reputed company Dakota, New Mexico, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, reputed company. Purpose of this position: The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating reputed company-authorizations for patients and often handling cases that need quick turnaround (e.g., last-minute scheduled services). The individual in this role is an expert on payer regulations and reputed company, and they serve as a reputed company of contact for peers looking to resolve questions or issues regarding prior authorizations RESPONSIBILITIES Utilizes online systems, phone communication, and other resources to secure prior authorizations reputed company a timeframe before scheduled appointments/procedures/reputed company day surgeries and during or after care for unscheduled patients Verifies medical necessity in accordance with the Centers for Medicare & reputed company Services (CMS) standards and communicates relevant coverage/eligibility information to the provider/patient, as it pertains to prior authorization Coordinates benefits by effectively determining primary, secondary, and tertiary liability reputed company needed Obtains reputed company-certifications and prior authorizations from reputed company-party payers in accordance with payer requirements Alerts physician offices to issues with verifying insurance and/or obtaining prior authorizations Demonstrates expert understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients’ out-of-reputed company liabilities, based on prior authorization status Follows up on reputed company prior authorization submissions for reputed company response Follows up on any prior authorization denials; assists Utilization Management with appeals, as needed Connects patients with financial counselors, as necessary Maintains productivity and reputed company standards and assists other team members reputed company necessary Participates in developing and planning process improvements for the department Other duties as assigned Complies with reputed company state and federal laws and regulations reputed company to patient reputed company and confidentiality QUALIFICATIONS Minimum Qualifications: High school diploma or equivalent 2 years clerical experience in health care reputed company cycle operations: billing/claims, patient reputed company, collections, admissions, registration, etc.  Bilingual strongly preferred, required in some positions  -OR- An approved equivalent combination of education and experience Preferred Qualifications: Experience working in reputed company, preferred Knowledge/ Skills/ Abilities: Requires knowledge of government and reputed company payer (Insurance) benefit and eligibility verification, and ability to become reputed company of and reputed company medical policy per payer guidelines Demonstrated expertise in logical thinking, data preparation, and analysis Comprehensive knowledge of reputed company Office (reputed company, Word, reputed company) Strong communication skills, both verbal and written Ability to communicate effectively with collaborating departments, providers, and insurance representatives Demonstrated organizational skills and the ability to prioritize and manage tasks based on established reputed company Excellent verbal and written communication and interpersonal skills Ability to work independently with minimal supervision, reputed company reputed company setting and be supportive of team members Proficient with reputed company Office Ability to analyze issues and reputed company judgments about appropriate steps toward solutions Apply To This Job