Prior Authorization Specialist I, Hospital Admissions, Full-Time

Community Hospital•Grand Junction, CO

14d•$19 - $22•Onsite

About The Position

This is a full-time position in Hospital Admissions focused on the Prior Authorization process. The role involves gathering patient information, verifying insurance coverage, submitting pre-authorization requests, and following up with insurance providers. The specialist will also communicate with healthcare providers, educate patients, maintain detailed records, and ensure compliance with relevant laws and regulations, including HIPAA.

Requirements

High school diploma or equivalent.
Knowledge of medical terminology preferred.

Nice To Haves

Knowledge of medical terminology

Responsibilities

Gather Patient Information: Collect and review patient medical records, diagnosis codes, and procedure details to support the pre-authorization request.
Verify Insurance Coverage: Confirm patient information and insurance coverage through verifying photo ID, insurance cards, and personal information.
Submit Pre-Authorization Requests: Prepare and submit pre-authorization requests to insurance companies, adhering to their specific procedures and requirements.
Follow Up: Monitor the progress of pre-authorization requests and follow up with insurance providers to expedite the approval process.
Communicate with Healthcare Providers: Collaborate with healthcare providers to obtain any necessary documentation, notes, or additional information required for pre-authorization.
Patient Education: Explain the pre-authorization process to patients, including potential out-of-pocket costs, and address any questions or concerns they may have.
Document and Recordkeeping: Maintain detailed records of pre-authorization requests, approvals, denials, and communications with insurance companies and healthcare providers.
Compliance: Ensure that all pre-authorization processes comply with relevant laws and regulations, including HIPAA (Health Insurance Portability and Accountability Act).