Prior Authorization Specialist

Prior Authorization Specialist, Full-time

$18-$23/hour

HMC Offers:

• Tuition Reimbursement
• Excellent benefits - health, dental, vision, and life and disability insurance
• Quality childcare located on site
• HMC Wellness Center membership
• 401(k) plan with employer match

Job Preview

The Prior Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Hopedale Medical Complex for scheduled services in accordance with the payer-provider contract. The representative will contact payers to request service authorizations and may collect financial and/or demographic information from patients as needed. The Prior Authorization Specialist is also responsible for determining insurance coverage for tests/procedures and counseling patients regarding this coverage, as well as performing financial counseling duties.

Responsibilities

Prior Authorizations:

• Verifies patient's insurance and benefits information.
• Obtains prior authorizations from third-party payers in accordance with payer requirements.
• Works with other departments to gather the clinical information required by the payer to authorize services.
• Maintains accurate records of authorizations within the EMR.
• Works with the business office 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.

Other Duties:

• Completes approved adjustments as requested and adds charges as requested.
• Keep filing updated for easy access.
• Keep the waiting area orderly throughout the day.
• Assist in maintaining accurate patient business records.
• Orders and maintains supplies as required.
• Maintains good working relationship both within the department and with other departments.
• Demonstrates an ability to be flexible, organized and function well in a stressful situation.
• Treat patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information.
• Follows established departmental policies, procedures, and objectives. Continues quality improvement objectives and safety, environmental and/or infection control standards.
• Other duties as assigned by the Patient Access Manager.

Job Requirements:

• Minimum of high school diploma. Some college or BA preferred.
• Knowledge of medical terminology and experience in medical office reception.
• Knowledge of patient registration procedures and documentation.
• Ability to prepare administrative paperwork and spreadsheets as requested.
• Ability to interact and communicate with people over the telephone, often in stressful situations.
• Above average ability to analyze and solve problems.
• Skill in the use of personal computers and Microsoft Office Suite (Word, Excel, Outlook).
• Excellent verbal and written communication skills required.
• Expert knowledge of insurance procedures and documentation of third-party medical insurance payers.
• Ability to work independently with little general supervision.
• Excellent telephone techniques and rapport. Experience with a multi-line phone system.
• Ability to perform the essential functions and requirements of the job with or without accommodation

Physical Demands

• Department is normal office environment.
• Ability to lift and move objects up to 25lbs.
• At times high patient traffic and stressful situations.
• In addition to the above requirements, some duties vary from sedentary to light exertion. Some of the duties will require the ability to get between buildings throughout Hopedale Medical Complex.

Compensation details: 18-23 Hourly Wage

PI5cac11f44b7c-29448-40561442

PDN-a2081521-f3cb-4ee6-8e5f-1981dd27e9ea