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Prior Authorization Specialist
2 months ago
Montrose Regional Health is a leading healthcare provider in the Uncompahgre Valley, offering personalized and professional healthcare services backed by the latest technology and expertise. As a not-for-profit accredited hospital, we strive to meet the highest standards of healthcare and are committed to being the hospital and healthcare resource of choice in our communities.
About the CareerThe Prior Authorization Specialist plays a critical role in facilitating the process from provider through payer to patient for timely healthcare diagnostics and treatments. This position requires a strong advocate for the patient's medical needs and financial health, ensuring that payer authorization is secured for medical services and patient health outcomes are optimized.
Key Responsibilities- Facilitate the prior authorization process for medical services, minimizing interruptions to ongoing treatments due to payer coverage restrictions or denials.
- Minimize patient financial risk by thoroughly reviewing health plan benefits and coverage restrictions, proactively advising providers and patients of any authorization delays or denials.
- Decrease hospital financial risk by interpreting provider clinical documentation for medical necessity requirements, utilizing available clinical resources for documentation improvement, and facilitating appeals for coverage denials.
- High school diploma or GED; prior authorization experience preferred.
- Able to achieve minimum level of core competencies and knowledge of procedure authorizations.
- Basic understanding of human anatomy.
- Identifies primary and secondary payers based on established payer coverage guidelines and criteria.
- Ability to prioritize workflow to meet deadlines.
- Student loan employer contributions up to $10,800 tax-free.
- Mentoring and continuing education opportunities.
- 401(k) retirement plan with employer match.
- Multiple health options to select from.
- Integrity and honesty in everything we do.
- Service with care and compassion.
- Excellence.
- Leadership with innovation and creativity.
- We care for our team like family.
