Post-Acute Prior Authorization Specialist
About The Position
The Post-Acute Authorization Specialist in the OSF Care Management department is responsible for initiating and obtaining new insurance authorization requests for post-acute services. Works collaboratively with case management team, hospital care team, community partners, and insurance companies to ensure that patient care needs are met regarding post-acute care prior authorizations. Obtains and maintains contacts with insurance companies to streamline barrier removal. Maintains knowledge of payer portal functionality and medical necessity requirements for post-acute care. Understands payer requirements and how to apply benefits in various circumstances for post-acute care and is responsible for identifying medical criteria for post-acute care from chart review and developing an effective clinical packet to justify the level of care needed.
Requirements
- High school diploma/GED with two years’ experience in insurance authorization
- Associate's degree in healthcare field with one year of experience in referral management
- One year of experience in insurance authorization.
- Solid computer skills, including proficiency with Microsoft software.
- Demonstrated proficiency in communicating sensitive complex information to persons in a hospital environment.
- Demonstrates the ability to work independently and execute their own workload.
- Critical thinking ability necessary to prioritize workload to ensure tasks are completed in a timely manner and within established timeframe.
- Interpersonal skills necessary to facilitate interpersonal communication with team members, department staff, and external personnel, interact with patients/families, and perform other activities requiring courtesy and tact.
Nice To Haves
- Bachelor's degree in a healthcare field.
- Ability to interact with members of the health care team and external personnel in order to exchange and gather patient care data to continue continuity of care.
- Accurate typing speed of at least 35 words per minute.
- Proven organizational skills in coordinating services with co-workers and other departments/services.
- Responds to stressful situations in a calm, rational manner and cooperates with all to facilitate integrated patient care that exceeds expectation.
- Strong analytical and problem-solving skills with the ability to be detail oriented.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
1-10 employees
