Prior Authorization Specialist, Hopedale IL Location, not a remote position Job at Hopedale Medical Complex, United States

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  • Hopedale Medical Complex
  • United States

Job Description

Prior Authorization Specialist, Onsite - This is not a remote position

  • HMC Offers:
  • Tuition Reimbursement
  • Excellent benefits - health, dental, vision, and life and disability insurance
  • Quality childcare located on site
  • HMC Wellness Center membership401(k) plan with employer match
  • Employee Daycare Rates
  • Infants (6 weeks to 15 months) - $133 weekly, $27 daily
  • Toddlers (15 months to 2 yrs) - $126 weekly, $26 daily
  • 2 years to 3 years - $119 weekly, $25 daily
  • 4 years to 5 years - $112 weekly, $23 daily

Job Preview

The Prior Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Hopedale Medical Complex for scheduled services in accordance with the payer-provider contract. The representative will contact payers to request service authorizations and may collect financial and/or demographic information from patients as needed. The Prior Authorization Specialist is also responsible for determining insurance coverage for tests/procedures and counseling patients regarding this coverage, as well as performing financial counseling duties. This is not a remote position, and candidates must be able to reasonably commute to Hopedale Illinois.

Responsibilities

Prior Authorizations:

  • Verifies patients insurance and benefits information.
  • Obtains prior authorizations from third-party payers in accordance with payer requirements.
  • Works with other departments to gather the clinical information required by the payer to authorize services.
  • Maintains accurate records of authorizations within the EMR.
  • Works with the business office to support appeal efforts for authorization related denials.
  • Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.
  • Maintains professional tone at all times when communicating with patients and payer representatives.

Other Duties:

  • Completes approved adjustments as requested and adds charges as requested.
  • Keep filing updated for easy access.
  • Keep the waiting area orderly throughout the day.
  • Assist in maintaining accurate patient business records.
  • Orders and maintains supplies as required.
  • Maintains good working relationship both within the department and with other departments.
  • Demonstrates an ability to be flexible, organized and function well in a stressful situation.
  • Treat patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information.
  • Follows established departmental policies, procedures, and objectives. Continues quality improvement objectives and safety, environmental and/or infection control standards.
  • Other duties as assigned by the Patient Access Manager.
  • Minimum of high school diploma. Some college or BA preferred.
  • Must be able to work on site here in Hopedale
  • Knowledge of medical terminology and experience in medical office reception.
  • Knowledge of patient registration procedures and documentation.
  • Ability to prepare administrative paperwork and spreadsheets as requested.
  • Ability to interact and communicate with people over the telephone, often in stressful situations.
  • Above average ability to analyze and solve problems.
  • Skill in the use of personal computers and Microsoft Office Suite (Word, Excel, Outlook).
  • Excellent verbal and written communication skills required.
  • Expert knowledge of insurance procedures and documentation of third-party medical insurance payers.
  • Ability to work independently with little general supervision.
  • Excellent telephone techniques and rapport. Experience with a multi-line phone system.
  • Ability to perform the essential functions and requirements of the job.

Physical Demands

  • Department is normal office environment.
  • Ability to lift and move objects up to 25lbs.
  • At times high patient traffic and stressful situations.
  • In addition to the above requirements, some duties vary from sedentary to light exertion. Some of the duties will require the ability to get between buildings throughout Hopedale Medical Complex.
  • Productivity and accuracy are monitored by the Patient Access Manager.

Compensation details: 19-22 Hourly Wage

PI7785ce583e23-26289-39244732

Job Tags

Hourly pay, Contract work, Work at office, Remote work, Flexible hours,

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