Job: Prior Authorization Specialist

Job Description

Job Type: Full time, Hourly

Wage: $18.66-$23.46/hr.

Location: Salida, CO.

Job Description:

HRRMC has an opening for a Full-Time (40hrs./wk.) Prior Authorization Specialist. Scheduled hours for this role will be Monday-Friday. This position is eligible for our full benefits package including employer matching retirement plans, vison, dental and health insurance, employee assistance program, on site employee gym and flex spending accounts.

ESSENTIAL DUTIES PER AREA OF RESPONSIBILITY

1. Greets patients, visitors, physicians and employees in a cordial and professional manner, being as helpful as possible. Directs people to appropriate areas.

2. Has full knowledge of all types of registration procedures and the various financial classes.

3. Is proficient in the use of the electronic health record, for the registration functions, referral and authorization functions.

4. Accurate interview and registration of new patients as well as updating demographic and insurance information on established patients

5. Capable of reading physician orders verifies the order with the patient/provider or service department.

6. Verifies patients' insurance and benefits information

7. Obtains prior authorizations from third-party payers in accordance with payer requirements.

8. Contacts provider offices, departments, and patients to gather demographic and insurance information as needed, and updates patient information within the system as necessary

9. Works with other departments to gather the clinical information required by the payer to authorize services.

10. Maintains accurate records of authorizations and referrals within the software.

11. Refers accounts to financial counseling as needed; if authorization is not obtained.

12. Works with business office staff to support appeal efforts for authorization-related denials.

14. Employs tact and courtesy at all times with patients, physicians, visitors and coworkers. Continually strives to establish and maintain good rapport and working relationships to foster positive intra-and interdepartmental communications.

15. Capable of performing all front desk and registration duties.

16. Performs other clerical duties as requested.

Requirements

IDEAL CANIDATE WILL HAVE EXPREINCE IN:

• Doctors office
• Familiarity with EMR and Medical Terminology

EDUCATION and/or EXPERIENCE

• Experience with Medical Electronic Healthcare systems preferred
• Two years related experience and/or training; or equivalent combination of education and experience.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must demonstrate high level of detail orientation.

2. Must be current on state-of-the-art office technology, including entire Microsoft Office Suite, and other office technologies.

3. Solid ability to handle highly confidential, sensitive information.

4. Position requires a high level of professionalism, tact, discretion, and integrity.

5. Must have the ability to work independently as well as collaboratively and adapt to changing priorities; demonstrate resourcefulness and good problem-solving skills 

**Disclaimer: The duties and responsibilities described above are not a comprehensive list and additional tasks may be assigned to the employee, time to time; the scope of the job may change as necessitated by business demands. Click “View Application” below for more detail on this specific job.