Prior Authorization Coordinator

4 weeks ago


Rapid City, South Dakota, United States Rapid City Medical Center Full time
Job Summary

Rapid City Medical Center is seeking a highly skilled Prior Authorization Specialist to join our West River ENT team. This role is responsible for managing the prior authorization process according to RCMC policies and procedures.

Key Responsibilities
  • Serve as a member of the clinic care team by providing exceptional service that further facilitates the ongoing care of patients.
  • Initiate prior authorizations as required by payers for diagnostic imaging procedures and specialized medications.
  • Process prior authorization requests accurately and efficiently in accordance with RCMC policy and procedures, communicating back to the nurse/provider team in a timely manner.
  • Meet productivity and accuracy standards for prior authorization processing.
  • Protect and maintain confidentiality and privacy of all prior authorization and member information.
  • Demonstrate ability to appear for work on time, possess 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.
  • Maintain confidentiality of all pertinent information to ensure employee, patient, and visitor rights are protected.
  • Handle all information regarding the organization in a manner that assures strictest confidentiality is maintained at all times.
  • Call on allergy and hearing aid benefits.
  • Perform other responsibilities as assigned based on business needs.
Requirements
  • High school diploma.
  • Minimum of one year work experience in medical service.
Preferred Qualifications
  • 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.
Work Environment
  • 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.


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