Pre-Authorization Specialist
About The Position
This position is responsible for screening prior-authorization and coordination of specialized services requested at Holton Community Hospital, including a broad range of requests for outpatients, ancillary and clinic services. Performs patient pre-registration, insurance verification, identifies prior authorization/notification requirements, finalizes patient financial information, informs the patient/guarantor of all financial liabilities and documents all information into the appropriate system. Communicate with patients, insurance companies and pertinent staff as necessary. Adheres to policies and procedures in order to comply with performance and compliance standards and to ensure cost effective and appropriate healthcare delivery. Maintains current knowledge of network resources for referral and linkage to member’s and provider’s needs. Authorizes certain specified services according to departmental guidelines.
Requirements
- Must have a High School Diploma
- Basic computer skills required.
- Strong knowledge of medical terminology and insurance processes.
- Familiarity with HIPAA regulations and patient privacy standards.
Nice To Haves
- Associate’s degree in Health Information Management, a Coding Certificate, or a technical degree program in healthcare or billing is Preferred.
- Prior coding experience preferred.
- Experience working in a healthcare or insurance environment, preferably in pre-authorization or medical billing.
- Proficiency with electronic health records (EHR) systems and insurance portals.
- Excellent communication and organizational skills
- Experience with specific insurance providers and their authorization procedures.
- Ability to analyze and resolve complex insurance denials.
Responsibilities
- Screen prior-authorization and coordination of specialized services.
- Perform patient pre-registration and insurance verification.
- Identify prior authorization/notification requirements.
- Finalize patient financial information.
- Inform the patient/guarantor of all financial liabilities.
- Document all information into the appropriate system.
- Communicate with patients, insurance companies and pertinent staff.
- Maintain current knowledge of network resources.
- Authorize certain specified services according to departmental guidelines.
Benefits
- Health
- Dental
- Vision
- Life
- Retirement Savings with Employer Match
- Health Savings Accounts, with Employer Match
- Flexible Spending Accounts, Medical & Dependent Care
- Supplemental Coverages including Short Term & Long Term Disability, Accident, Hospital Confinement, Cancer
- Paid Time Off
- Employee Assistance Program
- Flexible work environment that supports a healthy work-home life balance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
