Prior Authorization Specialist
4 weeks ago
Rapid City Medical Center has a Full-Time Prior Authorization Specialist position available. This position is responsible for managing the prior authorization process. It serves as an integral part of the patient care team while acting as a liaison between patients, scheduling, radiology, and clinical staff to deliver outstanding service and optimize patient flow. While working under general supervision, this position requires utilizing reasoning skills to identify missing or needed information and relying on policies and procedures to work independently to secure prior authorizations and use various business applications to perform analysis and enter necessary data.
Who We Are:
Rapid City Medical Center is a physician clinic providing excellence, choice, and patient-inspired care. We focus on building relationships with our patients, regularly connecting as partners on the journey of health. Our physicians use leading-edge technology to augment their medical skills. Ninety physicians and advanced practice providers work together with over 400 employees to make physician and test appointments efficient and effective and insurance interactions workable.
We thrive on working with smart, caring people. What we do is sometimes hard - but we do it because we serve our families, friends, and neighbors in something meaningful. Work-life balance and career satisfaction are important to us. Competitive wages and the opportunity to feel great about your job.
We offer an outstanding benefits package that includes health, dental, 401k, profit sharing, life insurance, short-term disability, and long-term disability, seven paid holidays and floating birthday, paid time off (PTO) accrual, as well as flexibility in the schedule to accommodate important personal and family milestones.
JOB DUTIES:
- Serves as a member of the clinic care team by providing service that further facilitates the ongoing care of that patient.
- Initiates prior authorizations as required by payers for diagnostic imaging procedures and specialized medications.
- Accurately processes prior authorization requests in accordance with RCMC policy and procedures and communicates back to nurse/provider team in a timely manner.
- Accountable to achieve prior authorization processing productivity and accuracy standards.
- Protects and maintains confidentiality and privacy of all prior authorization and member information.
- Demonstrates ability to appear for work on time, knowledge of medical terminology, follow directions from a supervisor and interact well with coworkers and patients.
- Develop, document, and maintain a prior authorization matrix for all payers.
- Maintains confidentiality of all pertinent information to assure that employee, patient, and visitor rights are protected.
- Handles all information regarding the organization in a manner that assures strictest confidentiality is maintained at all times.
- Other responsibilities as assigned based on business needs.
EXPERIENCE: Minimum of one year work experience in medical service.
KNOWLEDGE:
- Experience in business/professional written and verbal communication.
- General understanding of medical terminology, insurance billing, or coding background desirable.
- Exceptional customer relation skills.
- Intermediate level of computer knowledge with experience in Microsoft Office Products.
PHYSICAL/MENTAL DEMANDS:
- Ability to walk, stand, and sit for periods of time. Ability to sit and review information on a computer screen for extended periods of time.
- Normal motor skills and eye-hand coordination.
- Must have manual dexterity to operate computer keyboard and standard office equipment.
- Occasional stress from dealing with multiple projects.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or veteran status.
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