PAIN & SPINE - INSURANCE PRE-AUTHORIZATION SPECIALIST

MOUNTAIN VIEW HOSPITAL LLC • Idaho Falls, ID

1d • Onsite

About The Position

Mountain View Hospital is looking for an Insurance Pre-Authorization Specialist to join our team! This role is responsible for checking appointments and tasks/messages to ensure that the diagnosis and documentation support medical necessity as per insurance company guidelines, and to verify that all office visits and procedures requiring pre-authorization are indeed pre-authorized. The specialist will work closely with referring offices, acting as a resource to help them obtain necessary paperwork for pre-authorizations, prove medical necessity, or perform retro-authorizations. Collaboration with co-workers and vendor representatives is also key to getting visits/procedures approved. Mountain View Hospital and its affiliate clinics are dedicated to providing compassionate, cutting-edge care. The work environment is mission-driven, people-centric, and supportive, aiming to make coming to work exciting each day. This is an opportunity for a career where you can make a difference in the community.

Requirements

• High School graduate or equivalent.
• Ability to communicate well with patients, co-workers and vendor representatives.
• Continuously able to concentrate on fine detail with interruptions.
• Continuously able to attend to task/function for an extended period of time.
• Ability to learn computer programs and input data as required.
• Ability to work well with others.
• Writing skills necessary to properly submit preauthorization requests with insurance companies.
• Appropriate phone etiquette to properly submit preauthorization requests with insurance companies.
• Holds the judgment, tact and diplomacy to effectively resolve conflicts.

Nice To Haves

• Knowledge of diagnoses and CPT codes for pain management services preferred.
• Prior experience with coding and billing for outpatient billing is preferred.

Responsibilities

• Checks appointments and tasks/messages to make sure the diagnosis/documentation will support medical necessity, as per insurance company.
• Verify that all office visits and procedures that need preauthorization are pre-authorized.
• Works closely with referring offices to be used as a resource in helping them get necessary paperwork to start pre-authorizations, prove medical necessity, or to perform a retro-authorization.
• Works closely with co-workers and vendor representatives to get visits/procedures approved.

Benefits

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees