Prior Authorization Specialist
About The Position
This role plays a key part in ensuring RiverView Health is accurately reimbursed for scheduled services by confirming that payers are prepared to authorize coverage in line with existing contracts. The prior authorization representative proactively reaches out to payers to secure service approvals and may also gather essential financial or demographic details from patients when needed. This position operates under the direct supervision of the Director of Patient Financial Services and contributes to a seamless, efficient experience for both patients and the organization.
Requirements
- High school diploma or equivalent.
- 1 year Prior Authorization work
- Experience with EPIC EMR system
- Working knowledge of computers, excellent communication and organization skills
- Ability to work effectively in a team environment.
- Ability to work with little supervision and maintain a high level of performance
- Excellent organizational skills and attention to detail.
- Strong communication and interpersonal skills.
Nice To Haves
- Associate’s degree in healthcare or business administration and/or related/comparable experience preferred
Responsibilities
- Verifies patients’ demographic, insurance, and benefits information
- Obtains pre-authorization and pre-certifications from third-party payers in accordance with payer requirements, and documents the authorization number and period of validity in the EMR system (EPIC)
- Gathers additional medical records from other providers as needed to support medical necessity when obtaining a pre-authorization, and follows up with payers on pre-authorization requests as needed
- Alerts the clinicians involved in the patient’s care when there are issues with referrals or complications with insurance coverage
- Maintains accurate records of authorizations within the EMR system (EPIC)
- Identifies patients who will need to received Medicare Advance Beneficiary Notices of Noncoverage (ABNs)
- Refers accounts to financial counseling as needed if authorization is not obtained
- Works with business office staff to support appeal efforts for authorization-related denials
- Complies with HIPAA regulations, as well as the organization’s policies and procedures regarding patient privacy and confidentiality
- Maintains professional tone at all times when communicating with patients and payer representatives
- Performs other duties as requested
Benefits
- We have a robust scholarship program for those furthering their education in a medical field, excellent benefits, and a friendly work environment.
- Full-time benefits include health insurance, free single vision and basic dental insurance, life insurance, long-term disability and short-term disability, and employer HSA contributions.
- Other benefits include employer pension matching, shift differential, incentive/premium pay, free annual biometric screening and paid volunteer time off.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
251-500 employees
