Prior Authorization Specialist - Radiation Oncology - Full Time

Montrose Regional Health•Montrose, CO

9d•Onsite

About The Position

The Hospital Prior Authorization Specialist is an advocate for the patient's medical needs and financial health as they facilitate the process from provider through payer to patient for timely health care diagnostics and treatments. The Prior Authorization Specialist supports the provider and patient's plan of care as they secure payer authorization for medical services and optimize patient health outcomes by minimizing interruptions to ongoing treatments due to payer coverage restrictions or denials. Secondly, the Prior Authorization Specialist minimizes the patient's financial risk with a thorough review of the health plan benefits and coverage restrictions, proactively advising the provider and patient of any authorization delay or denial. The Prior Authorization Specialist also decreased the Hospital financial risk by interpreting the provider's clinical documentation for medical necessity requirements, utilizing available clinical resources for documentation improvement, and facilitating appeals for coverage denials.

Requirements

High school diploma or GED
Able to achieve minimum level of core competencies and knowledge of procedure authorizations.
Basic understanding of human anatomy.
Identifies primary and secondary payers, based on established payer coverage guidelines and criteria.
Ability to prioritize workflow to meet deadlines.

Nice To Haves

Prior Authorization experience preferred.

Responsibilities

Facilitate the process from provider through payer to patient for timely health care diagnostics and treatments.
Secure payer authorization for medical services.
Minimize interruptions to ongoing treatments due to payer coverage restrictions or denials.
Review health plan benefits and coverage restrictions.
Advise the provider and patient of any authorization delay or denial.
Interpret the provider's clinical documentation for medical necessity requirements.
Utilize available clinical resources for documentation improvement.
Facilitate appeals for coverage denials.