Prior Authorization Rep Sr

Hennepin Healthcare•Minneapolis, MN

9d•Remote

About The Position

The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating pre-authorizations for patients, including cases requiring quick turnaround such as last-minute scheduled services. The individual is an expert on payer regulations and contracts and serves as a point of contact for peers seeking help with prior authorization questions or issues. This role is in the Financial Securing department, is 1.00 FTE (80 hours per pay period), and is remote. Workdays are Monday through Friday, with an 8-hour day shift. Hennepin Healthcare lists Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Mississippi, Nevada, North Carolina, North Dakota, New Mexico, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin as non-Minnesota states where it is an eligible employer.

Requirements

High school diploma or equivalent.
Two years of clerical experience in healthcare revenue cycle operations, such as billing/claims, patient accounting, collections, admissions, or registration; alternatively, an approved equivalent combination of education and experience.
Knowledge of government and commercial payer benefits and eligibility verification, and ability to learn and navigate medical policy according to payer guidelines.
Demonstrated logical thinking, data preparation, and analysis expertise.
Comprehensive knowledge of Microsoft Office, including Outlook, Word, and Excel.
Strong verbal and written communication skills.
Ability to communicate effectively with collaborating departments, providers, and insurance representatives.
Organizational skills and ability to prioritize and manage tasks according to established criteria.
Interpersonal skills.
Ability to work independently with minimal supervision within a team setting and support team members.
Proficiency with Microsoft Office.
Ability to analyze issues and make judgments about appropriate steps toward solutions.

Nice To Haves

Bilingual skills are strongly preferred and required in some positions.
Experience working in EPIC.

Responsibilities

Use online systems, phone communication, and other resources to secure prior authorizations within the required timeframe before scheduled appointments, procedures, or same-day surgeries, and during or after care for unscheduled patients.
Verify medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicate relevant coverage and eligibility information to providers and patients as it relates to prior authorization.
Coordinate benefits by determining primary, secondary, and tertiary liability when needed.
Obtain pre-certifications and prior authorizations from third-party payers in accordance with payer requirements.
Alert physician offices to issues with insurance verification or obtaining prior authorizations.
Apply expert understanding of insurance terminology and analyze information to determine patients’ out-of-pocket liabilities based on prior authorization status.
Follow up on all prior authorization submissions to obtain timely responses.
Follow up on prior authorization denials and assist Utilization Management with appeals as needed.
Connect patients with financial counselors as necessary.
Maintain productivity and quality standards and assist other team members when necessary.
Participate in developing and planning departmental process improvements.
Perform other duties as assigned.
Comply with state and federal laws and regulations related to patient privacy and confidentiality.