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Prior Authorization Rep Sr, Financial Securing

4 months ago

Minneapolis, United States Minnesota Visiting Nurse Agency Full time

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 Title: Prior Authorization Rep Sr, Financial Securing Location: MN-Minneapolis-Downtown Campus Requisition ID: 240937