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Prior Authorization Rep Sr, Financial Securing

4 months ago

Minneapolis, Minnesota, United States Hennepin County Medical Center Full time

Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in the North Loop, Whittier, and East Lake Street neighborhoods of Minneapolis, and in the suburban communities of Brooklyn Park, Golden Valley, Richfield, and St. Anthony Village. Hennepin Healthcare has a large psychiatric program, home care, and operates a research institute, philanthropic foundation, and Hennepin EMS. The system is operated by Hennepin Healthcare System, Inc., a subsidiary corporation of Hennepin County.

Equal Employment Opportunities: We believe equity is essential for optimal health outcomes and are committed to achieve optimal health for all by actively eliminating barriers due to racism, poverty, gender identity, and other determinants of health. We are committed to equitable care and working in an environment that celebrates, promotes, and protects diversity, equity, inclusion, and belonging. We are committed to bringing in individuals with new cultural perspectives to assist in creating a more equitable healthcare organization.

SUMMARY:
We are currently seeking a Prior Authorization Representative Senior to join our Financial Securing team. This full-time role will primarily work remotely (SHIFT: Days).

Purpose of this position: The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating pre-authorizations for patients and often handling cases that need quick turnaround (e.g., last-minute scheduled services). The individual in this role is an expert on payer regulations and contracts, and they serve as a point of contact for peers looking to resolve questions or issues regarding prior authorizations

RESPONSIBILITIES:

  • Utilizes online systems, phone communication, and other resources to secure prior authorizations within a timeframe before scheduled appointments/procedures/same day surgeries and during or after care for unscheduled patients
  • Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the provider/patient, as it pertains to prior authorization
  • Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed
  • Obtains pre-certifications and prior authorizations from third-party payers in accordance with payer requirements
  • Alerts physician offices to issues with verifying insurance and/or obtaining prior authorizations
  • Demonstrates expert understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients' out-of-pocket liabilities, based on prior authorization status
  • Follows up on all prior authorization submissions for timely response
  • Follows up on any prior authorization denials; assists Utilization Management with appeals, as needed
  • Connects patients with financial counselors, as necessary
  • Maintains productivity and quality standards and assists other team members when necessary
  • Participates in developing and planning process improvements for the department
  • Other duties as assigned
  • Complies with all state and federal laws and regulations related to patient privacy and confidentiality

QUALIFICATIONS:
Minimum Qualifications:

  • High school diploma or equivalent
  • 2 years clerical experience in health care revenue cycle operations: billing/claims, patient accounting, collections, admissions, registration, etc.
  • Bilingual strongly preferred, required in some positions

-OR-

  • An approved equivalent combination of education and experience

Preferred Qualifications:

  • Experience working in EPIC, preferred
  • Experience submitting mental health prioritizations

Knowledge/ Skills/ Abilities:

  • Requires knowledge of government and commercial payer (Insurance) benefit and eligibility verification, and ability to become aware of and navigate medical policy per payer guidelines
  • Demonstrated expertise in logical thinking, data preparation, and analysis
  • Comprehensive knowledge of Microsoft Office (Outlook, Word, Excel)
  • Strong communication skills, both verbal and written
  • Ability to communicate effectively with collaborating departments, providers, and insurance representatives
  • Demonstrated organizational skills and the ability to prioritize and manage tasks based on established criteria
  • Excellent verbal and written communication and interpersonal skills
  • Ability to work independently with minimal supervision, within a team setting and be supportive of team members
  • Proficient with Microsoft Office
  • Ability to analyze issues and make judgments about appropriate steps toward solutions

You've made the right choice in considering Hennepin Healthcare for your employment. We offer a wealth of opportunities for individuals who want to make an impact in our patients' lives. We are dedicated to providing Equal Employment Opportunities to both current and prospective employees. We are driven to connect talented individuals with life-changing career opportunities, enabling you to provide exceptional care without exception. Thank you for considering Hennepin Healthcare as a future employer.

Please Note: Offers of employment from Hennepin Healthcare are conditional and contingent upon successful clearance of all background checks and pre-employment requirements.

Department: Financial SecuringPrimary Location: MN-Minneapolis-Downtown Campus Standard Hours/FTE Status: FTE = hours per pay period)Shift Detail: DayJob Level: StaffEmployee Status: Regular Eligible for Benefits: YesUnion/Non Union: Union Job Posting: May

EEO/Disability/Veteran employer.