Scheduling and Prior Authorization Specialist

Job Description Summary:

This position is responsible for obtaining prior authorizations for all procedural orders by successfully completing the prior authorization process per department procedure and protocol.

Qualifications:

+ Minimum of two (2) years' experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required.

+ Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required.

+ Possess a working knowledge and understanding of ICD-9 and CPT codes required.

+ Possess i nsight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required.

+ Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed. Meditech experience preferred.

+ Excellent verbal and written communication skills including the ability to communicate effectively with various audiences .

+ Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.

+ Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.

Job Specific Duties:

+ Responsible for obtaining accurate prior authorizations for facility and professional charges related to scheduled patient appointments per department procedure and protocol.

+ Performs timely and accurate submission of CPT, HCPCS codes and medical records to insurance carriers to expedite prior authorization requests.

+ Accurately secures patients' demographics and medical information and ensures all procedures are in line with HIPPA compliance and regulations.

+ Reviews accuracy and completeness of information requested and ensures all supporting documents are present. Collaborates with stakeholders as appropriate.

+ Prioritizes incoming authorization requests according to department procedure and protocol. Confirms accuracy of CPT and ICD 10 diagnoses in the procedure order.

+ Maintains the Logan Health intranet related to payer requirements needed to successfully obtain a prior authorization.

+ Contacts patient and/or clinic to advise if authorization request has not been obtained prior to date of service.

+ Researches and works with appropriate stakeholders in initiating retro authorization requests and resolving authorization denials as needed. Prepares, submits, and tracks appeals as necessary. Accurately documents patient accounts of all actions taken.

+ Informs, educates, and communicates with leadership to include, but may not be limited to; billing or authorization concerns, backlogs, insurance issues, problematic accounts, documentation issues, etc.

+ Adapts to changing circumstances to meet the needs of patient flow.

+ Exhibits written and verbal professionalism at all times when interacting with others. Ensures all departmental transactions and interactions are completed with integrity, confidentiality, and professionalism.

+ The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.

Maintains regular and consistent attendance as scheduled by department leadership.

Shift:

Day Shift - Variable Hours (United States of America)

Schedule Details:

Please know schedules and shifts are subject to change based on patient care and department/organizational needs.

Schedule:

Logan Health operates 24 hours per day, seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

Notice of Pre-Employment Screening Requirements

If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:

+ Criminal background check

+ Reference checks

+ Drug Screening

+ Health and Immunizations Screening

+ Physical Demand Review/Screening

Equal Opportunity Employer

Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability or any other basis protected by applicable law. If you require accommodation to complete the application, testing or interview process, please notify Human Resources.

The Planetree Culture at Logan Health - Whitefish

Thank you for your interest in Logan Health - Whitefish where we believe everyone who works at our hospital and clinics is a caregiver. At Logan Health - Whitefish our employees are motivated by our open and supportive culture of caring for the patient and each other.

Logan Health - Whitefish was the first hospital in Montana to be affiliated with Planetree International, a non-profit organization setting the global standard for person-centered care. As a Planetree affiliate, we embrace this evidence-based approach partnering with the patient and their family to provide the highest quality patient experience. Logan Health - Whitefish is often recognized as one of the top critical access hospitals in the country and received a 5-star overall rating, the highest designation available for hospitals from the Centers for Medicare and Medicaid Services in 2023. We take pride in providing our quality level of service and continuously work to go above and beyond our stellar reputation.

Our people are everything.

The amazing providers, employees, and volunteers at Logan Health gift this organization with their innovation, knowledge, and compassion. Together, we're connecting our community to trusted, quality care and helping to improve lives every day.

Do you dream of living and working in a beautiful area surrounded by stunning scenery and endless recreation?

Are you ready to evolve your career while working alongside passionate, talented, brilliant people?

Join our remarkable team and create positive patient experiences every day