Prior Authorization Specialist

3 weeks ago

Duluth, United States Saint Luke's Hospital of Duluth Full time
  • JOB SUMMARY
    • The Prior Authorization Specialist/Financial Counselor, under the direction of the Manager, Central Billing Office, serves as two major functions as a St. Luke's employee:

      First, responsible for verifying health insurance, obtaining benefits and meeting payer requirements to secure prior authorizations for medications. Verifying insurance coverage, resolving any issues with authorization and escalating complicated issues to appropriate manager. The Prior Authorization Specialist acts as a liaison between patients, their health insurance, and care providers to assist in the understanding of their pharmacy benefit and responsibility.

      Second, will serve as the primary contact for patient reimbursement issues in accordance with established policies. The Financial Counselor provides information to patient or patient's family regarding clinic payment requirements, alternative financing and financial assistance programs. All communications are conducted in a manner that will result in positive patient relations and prompt reimbursement for services.
  • MINIMUM QUALIFICATIONS
    • Education: High School graduate or equivalent.
    • Experience: At least one (1) year of experience in healthcare, finance, or related setting.
    • Licensure/Certification/Registration: N/A
  • PREFERRED QUALIFICATIONS
    • Education: Associates Degree in related field.
    • Experience: Training and/or experience in follow-up or collection technique, medical terminology, and medical records coding and/or managed care reimbursement.
    • Licensure/Certification/Registration: Registered Technician with Minnesota Board of Pharmacy.
  • KNOWLEDGE, SKILLS AND ABILITIES
    • Knowledge of Microsoft Outlook, Word and Excel. Strong computer skills and current computer technology experience. Ability to demonstrate strong personal interaction skills. Must demonstrate good written and verbal communication skills as well as analytical capabilities. Communication activities promote positive patient relations and prompt reimbursement. Knowledgeable in office functions and processes.
    • READING - Intermediate: Ability to read and interpret documents such as operating and maintenance instructions and procedure manuals.
    • WRITING - Intermediate: Ability to write routine reports, correspondence, or procedures.
    • SPEAKING - Intermediate: Ability to effectively present information in one-on-one, small group situations or before groups of customers, clients, and other employees of the organization.
    • MATHEMATICAL SKILLS - Intermediate Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals and to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to compute rate, ratio, and percent and to draw or interpret bar graphs to apply concepts of basic algebra and geometry.
    • REASONING ABILITY - Intermediate Skills: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
  • PHYSICAL DEMANDS AND ENVIRONMENT
    • PHYSICAL DEMANDS
      • Ability to talk, hear, sit, stand, and reach for a period of eight (8) hours
      • Stand - Occasionally Under 1/3 (1-2.5 hours)
      • Walk - Occasionally Under 1/3 (1-2.5 hours)
      • Sit - Continuously Over 2/3 (5.5 - 8 hours)
      • Use hands to finger, handle, or feel - Continuously Over 2/3 (5.5 - 8 hours)
      • Reach with hands and arms - Occasionally Under 1/3 (1-2.5 hours)
      • Stoop, squat, kneel, or crouch - Occasionally Under 1/3 (1-2.5 hours)
      • Bending-repetitive forward - Occasionally Under 1/3 (1-2.5 hours)
      • Talk or hear - Continuously Over 2/3 (5.5 - 8 hours)
    • LIFTING REQUIREMENTS
      • Up to 10 pounds - Frequently 1/3 to 2/3 (2.5 - 5.5 hours)
      • Up to 25 pounds - Occasionally Under 1/3 (1-2.5 hours)
    • WORK ENVIRONMENT
      • Typical Noise Level - Moderate noise (examples: business office with computers and printers, light traffic)
    • WORKING CONDITIONS
      • Typical office environment with computer usage

  • Medical Assistant/Prior Authorizations Specialist

    1 week ago

    Duluth, Georgia, United States Anne Arundel Dermatology Full time

    About the RoleWe are seeking a highly skilled and detail-oriented Medical Assistant/Prior Authorizations Specialist to join our team at Anne Arundel Dermatology. As a key member of our healthcare team, you will play a critical role in ensuring that our patients receive timely and appropriate approval for medical treatments, procedures, and...

  • Insurance Authorization Specialist

    1 week ago

    Duluth, Georgia, United States Northside Hospital Inc. Full time

    Position Summary:Northside Hospital is a leading healthcare provider, recognized for its innovative approach and commitment to excellence. As we continue to enhance the quality of care for our patients and communities, we invite skilled healthcare professionals to explore the diverse career opportunities available at Northside.Key...

  • Patient Referral Specialist

    1 week ago

    Duluth, Minnesota, United States MEDLOCK PEDIATRICS PC Full time

    Job OverviewWe are looking for a Patient Referral Specialist to facilitate communication between patients and pediatric specialists. This role involves managing a significant volume of phone interactions with patients and their guardians, as well as with healthcare providers.Key Responsibilities:Coordinate and schedule appointments for eligible patients and...

  • Safety and Security Specialist

    2 weeks ago

    Duluth, Minnesota, United States Center for Alcohol and Drug Treatment Full time

    Position OverviewRole SummaryThe Safety and Security Specialist is tasked with overseeing the safety protocols at the Center for Alcohol and Drug Treatment, ensuring a secure environment for both patients and staff. This role involves managing access to the facility, addressing potential disturbances, and maintaining a vigilant presence throughout the...

  • Pharmacovigilance Specialist

    4 weeks ago

    Duluth, United States TalentBurst Full time

    Title: Pharmacovigilance Specialist Location: St. Joseph, MO 64506 or Duluth, GA 30096 Duration: 12 Months Shift: Hours - 8-5 M-F Duties: This would be a site-based position and the candidate would be required to be on-site at one of the locations (Duluth or ST Joseph) a minimum of 2 days/week. Basic purpose of the job: Ensures Pharmacovigilance...

  • Room Care Associate

    2 weeks ago

    Duluth, Minnesota, United States Highgate Hotels Full time

    Position Overview:The Guest Room Specialist is responsible for ensuring that all guest accommodations are impeccably maintained and sanitized. This role involves adhering to a detailed cleaning protocol that aligns with both brand standards and health guidelines.Key Responsibilities:1. Conduct thorough cleaning and sanitization of guest rooms.2. Ensure...

  • Biomedical Equipment Support Specialist

    3 months ago

    Duluth, Minnesota, United States Department Of Health And Human Services Full time

    Summary This position is a Biomedical Equipment Support Specialist, Division of Facilities Management, located at the Duluth Field Office, Duluth, MN. This position reports to the Clinical Engineering Director or designee.Open until Filled: This announcement is open until the vacancy is filled. It may be extended or closed prior to the current closing date....

  • Biomedical Equipment Support Specialist

    3 months ago

    Duluth, United States Department Of Health And Human Services Full time

    Summary This position is a Biomedical Equipment Support Specialist, Division of Facilities Management, located at the Duluth Field Office, Duluth, MN. This position reports to the Clinical Engineering Director or designee. Open until Filled: This announcement is open until the vacancy...

  • Traveling CT Imaging Specialist

    1 week ago

    Duluth, Minnesota, United States LeaderStat Full time

    Position Overview:LeaderStat is currently seeking a traveling CT Imaging Specialist for an exciting opportunity.Job Details:Specialty: CT Imaging SpecialistDiscipline: Allied Health ProfessionalEmployment Type: TravelDuration: 13 weeksWeekly Hours: 40 hoursShift: 8 hours, eveningsRequirements:Experience with Siemens CT systems is essential.A minimum of 2...

  • Patient Engagement Specialist

    2 weeks ago

    Duluth, Minnesota, United States Center for Alcohol and Drug Treatment Full time

    Peer Recovery Support Specialist Job OverviewThe Center for Alcohol & Drug Treatment is on the lookout for a dedicated Peer Recovery Support Specialist to enhance our team at the Office Based Opioid Treatment (OBOT) facility. This role serves as the initial point of contact for individuals seeking assistance, delivering exceptional customer service and...

  • Customer Engagement Specialist

    2 weeks ago

    Duluth, Minnesota, United States DBS Residential Solutions Inc Full time

    Become a Part of Our Team as a Customer Engagement SpecialistDBS Residential Solutions Inc, a prominent provider in basement waterproofing, foundation repair, and energy efficiency solutions, is on the lookout for a committed individual to fill the role of Customer Engagement Specialist. If you have a passion for delivering exceptional customer support and...

  • Janitorial Specialist

    5 days ago

    Duluth, Minnesota, United States ABM Full time

    About the JobThe Janitorial Specialist provides the cleaning and upkeep of an assigned area. This role is ideal for individuals who are looking to enter the workforce or return to the workforce with limited experience and education.ResponsibilitiesClean and maintain buildings and facilities to ensure a safe and healthy environment for clients and...

  • Nursing Specialist

    6 days ago

    Duluth, Minnesota, United States Essentia Health Full time

    Job SummaryEssentia Health is seeking a skilled Registered Nurse to join our team. As a Nursing Specialist, you will be responsible for providing high-quality patient care in a variety of settings, including primary and specialty care outpatient facilities, non-acute community outpatient settings, and telehealth nursing encounters.Key ResponsibilitiesAssess...

  • Accounts Receivable Specialist

    1 week ago

    Duluth, Georgia, United States Nth Degree Full time

    Position OverviewAt Nth Degree, we specialize in creating impactful experiences that enhance brand visibility through trade shows, exhibits, and events. Our commitment to excellence drives us to seek a dedicated Billing Specialist to join our Finance team.As a Billing Specialist, you will serve as a key point of contact for billing processes and management,...

  • Accounts Receivable Specialist

    1 week ago

    Duluth, Georgia, United States Nth Degree Full time

    Position OverviewAt Nth Degree, we specialize in creating impactful experiences through trade shows, exhibits, and events that enhance brand visibility. Our commitment to excellence drives us to seek a dedicated Billing Specialist to join our Finance team.As a Billing Specialist, you will serve as a crucial link between billing operations and management,...

  • Traveling CT Imaging Specialist

    2 weeks ago

    Duluth, Georgia, United States Health Advocates Network-Rochester Full time

    Health Advocates Network-Rochester is currently seeking a traveling CT Imaging Specialist for an exciting opportunity. Position OverviewThis role is designed for a dedicated CT Imaging Specialist who is ready to take on a travel assignment. Key ResponsibilitiesSpecialty: CT ImagingDiscipline: Allied Health ProfessionalEmployment Type: TravelWeekly Hours: 36...

  • Compliance and Licensing Specialist

    2 weeks ago

    Duluth, Minnesota, United States Talent Equity Group Full time

    Talent Equity Group is looking for a Compliance and Licensing Specialist to enhance our team. The Compliance and Licensing Specialist is essential to our operations, providing vital administrative and licensing assistance while ensuring adherence to all necessary corporate, contractor, and local licensing regulations. This position will work closely with the...

  • Specimen Collection Specialist

    2 weeks ago

    Duluth, Minnesota, United States Millennium Health Full time

    Full Time Specimen Collection SpecialistLocation: Duluth, MinnesotaSchedule: Full Time. Schedule VariesSeeking: Candidates must be willing to travel around Northern MinnesotaJoin our team at Millennium Health LLC, a certified specialty laboratory focused on medication monitoring and drug testing services. We are in search of a Specimen Collection Specialist...

  • Pediatric Gastroenterology Specialist

    2 weeks ago

    Duluth, Minnesota, United States RecruitWell LLC Full time

    Position Overview: Pediatric Gastroenterology SpecialistClinical Responsibilities:Referral Incentives: We encourage you to refer qualified candidates for this role.Become part of the leading pediatric healthcare provider in the region, collaborating with a dedicated team of 11 outpatient pediatricians and various pediatric subspecialists.Our facility...

  • Veterinary Pharmacovigilance Specialist

    2 weeks ago

    Duluth, Minnesota, United States Aequor Full time

    Veterinary Pharmacovigilance SpecialistLocation: RemoteDuration: Long-term ContractHours: Standard Business HoursThis position requires the selected candidate to engage in on-site activities at designated locations on a part-time basis.Job Overview:The role is pivotal in ensuring adherence to pharmacovigilance regulations set forth by relevant authorities,...