Prior Authorization Specialist - Almara OGI Edina

Revo Health • Edina, MN

1d • Onsite

About The Position

The Prior Authorization Specialist is responsible for efficiently working accounts receivable for the organization, while maintaining customer service. This position will focus on obtaining prior authorization for procedures. This is a full-time role, Monday - Friday 8:00 AM - 4:30 PM, flexible based upon business need out of our Edina location. Almara Women's Health | Obstetrics, Gynecology & Infertility is an operating division of Infinite Health Collaborative (i-Health), a group of local medical practices, owned and led by its physicians, on a mission to give patients more control over their healthcare.

Requirements

• High School diploma/GED or equivalent
• Customer service experience
• Insurance knowledge in commercial, work comp, and government payers required
• Ability to: Comply with company policies, procedures, practices, and business ethics guidelines.
• Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
• Demonstrate prompt and reliable attendance.
• Work at an efficient and productive pace, handle interruptions appropriately, and meet deadlines.
• Prioritize workload effectively.
• Communicate respectfully and professionally in face-to-face, phone and email interactions.
• Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions.

Nice To Haves

• Previous experience in a healthcare facility in prior authorization preferred.
• Medicare experience strongly preferred.

Responsibilities

• Coordinates and processes medical prior authorizations for surgical/procedures by reviewing insurance and submitting information needed for coverage
• Able to triage incoming calls and requests form provider groups/patient for authorization of services, questions, status updates
• Ensure professional communication with patients, clinic personnel, and outside vendors whether over the phone, via email or other written documentation and respond to all inquiries
• Maintain a working knowledge of health care plan requirements and health plan networks
• Verify and document insurance information as defined by current business practices
• Review Explanation of Benefits (EOB), research denials, rejections
• Ensure appropriate forms are used when requesting authorizations, insurance transfers or other specific account changes
• Make outbound phone calls to patients, clinical staff, partner facilities and insurance companies
• Take inbound calls from patients, clinical staff, partner facilities and insurance companies
• Any and all other duties as assigned

Benefits

• Employees working 30+ hours per week (60 hours per pay period) are eligible for our Medical (w/Maternity Bundle), Dental & Vision plans, as well as Tuition Reimbursement.
• All employees, regardless of hours, are eligible for 401(k) w/ Profit Sharing, Employee Assistance Program, Lifetime Fitness Subsidy, Car Rental discounts, Home, Auto, & Pet insurance savings programs & more.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED