Prior Authorization & Scheduling Specialist | Logan Health Cut Bank

Job Profile Summary

This position is responsible for obtaining prior authorizations for procedural orders by accurately and efficiently completing the authorization process in accordance with department procedures and protocols, while also providing patient scheduling and administrative support to promote efficient operations, enhance the patient experience, and support optimal patient care.

Qualifications

• Minimum of two (2) years of experience in an acute care hospital, specialty clinic, medical billing, or patient scheduling, with experience obtaining pre-certifications or prior authorizations required.
• Knowledge and understanding of commercial and government insurance requirements, medical terminology, and regulations governing the handling of protected health information (PHI) required.
• Working knowledge and understanding of ICD-10 and CPT coding required.
• Knowledge and understanding of reimbursement and claims processes and their impact on the revenue cycle required.
• Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed. Meditech experience preferred.
• Promotes excellence through setting high standards and providing high quality outcomes.
• Ability to act with integrity, kindness, and exhibit empathy.
• Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
• Commitment to working in a team environment and maintaining confidentiality as needed.
• Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.

Job Specific Duties

• Obtains accurate prior authorizations for facility and professional charges associated with scheduled patient appointments in accordance with department procedures and protocols.
• Submits CPT and HCPCS codes and supporting medical records to insurance carriers accurately and timely to facilitate prior authorization requests.
• Obtains and verifies accurate patient demographic and medical information while ensuring compliance with HIPAA requirements and regulations.
• Reviews authorization requests for accuracy and completeness and ensures all required supporting documentation is included. Collaborates with appropriate stakeholders to obtain additional information as needed.
• Prioritizes incoming authorization requests in accordance with department procedures and protocols. Verifies the accuracy of CPT codes and ICD-10 diagnosis codes associated with procedure orders.
• Maintains and updates the Logan Health intranet with payer requirements and information necessary to support the prior authorization process.
• Contacts patients and/or clinics when authorization has not been obtained prior to the scheduled date of service and communicates applicable next steps.
• Researches and collaborates with appropriate stakeholders to initiate retroactive authorization requests and resolve authorization denials as needed. Prepares, submits, and tracks appeals as appropriate and accurately documents all actions taken in patient accounts.
• Communicates relevant concerns and updates to leadership, including authorization and billing concerns, backlogs, insurance issues, problematic accounts, and documentation deficiencies.
• Schedules services and procedures accurately in accordance with department protocols and the needs of assigned areas. Effectively communicates and verifies patient preparation instructions, as applicable.
• Coordinates resources to ensure the appropriate availability of equipment and supplies, as applicable to assigned areas.
• Communicates professionally, effectively, and clearly in both verbal and written interactions. Maintains confidentiality and protects patient privacy in accordance with HIPAA requirements. Works efficiently and calmly under stressful conditions, during periods of high patient volume, and when managing additional workloads.
• Collaborates with assigned area leadership and staff to support daily operations and ensure timely completion of responsibilities.
• Works cooperatively with appropriate departments to identify and resolve duplicate accounts and other registration or scheduling discrepancies, as applicable.
• Maintains databases and related information in accordance with department procedures and protocols and the needs of assigned areas.
• Adapts to changing circumstances and priorities to support patient flow and departmental operations.
• Demonstrates professionalism, integrity, and confidentiality in all departmental transactions and interactions.

Additional information

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position..

Shift: Day Shift - Variable Hours (United States of America)

Schedule Monday - Friday

Notice of Pre-Employment Screening Requirements

If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:

• Criminal background check
• Reference checks
• Drug Screening
• Health and Immunizations Screening
• Physical Demand Review/Screening