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Prior Authorization Specialist

3 months ago

Concord, Massachusetts, United States Emerson Hospital Full time
Prior Authorization Specialist - hybrid after onsite training - Full Time 8am-4:30pm
Job Ref: 29723

Category: Clerical & Administrative Support

Location:

Emerson Hospital,
133 Old Road to Nine Acre Corner,

Concord,
MA 01742

Department: Patient Access

Schedule: Full Time

Shift: Day shift

Hours: 8:00-4:30

Job Summary Reports to the Direct of Patient Access, the position serves as the hospital`s primary contact for patient reimbursement issues in accordance with established credit policies. The position works with third-party payors for necessary authorizations and verification of coverage issues. The position also provides cashiering services for Emerson Hospital. Minimum Qualifications
  • Education
    • High School Diploma or equivalent required.
    • Associates Degree preferred.
    • Work experience may be substituted for higher education.
  • Experience
    • One to 3 years as a financial counselor at a hospital and/or authorization coordinator required
      and/or
      3-5 years full-time admitting experience with insurance knowledge required
    • Knowledge of insurances, pre certification and referral procedures required
    • Knowledge of the Virtual Gateway and Medicaid applications preferred
    • Experience in working with patients required
    • Experience in working with payers to appeal pre auth denials preferred
  • Licensure and/or Certification
    • None required
  • Skills
    • Knowledge of third party payors.
    • Knowledge of Medicare billing practices and regulations.
    • Insurance verifications experience.
    • Computer proficiency.
    • Excellent interpersonal skills are required to interact effectively with all organizational levels, with demonstrated organizational skills and ability to work accurately with detailed confidential information.
    • Must have the ability to read, write and communicate in English.
    • Must be highly organized, cooperative, and able to work well with others.
    • Ability to prioritize and perform multiple tasks.
    • Thorough understanding of team management concepts.
    • Comprehensive knowledge of medical terminology.
    • The ability to effectively communicate with external organizations as well as various levels of management required.