[Remote] Prior Authorization Specialist, Hopedale IL Location, not a remote position

Note: The job is a remote job and is open to candidates in USA. Hopedale Medical Complex is seeking a Prior Authorization Specialist to ensure reimbursement for scheduled services in line with payer-provider contracts. The specialist will contact payers for service authorizations, determine insurance coverage for tests/procedures, and provide financial counseling to patients.

Responsibilities

• Verifies patient’s insurance and benefits information
• Obtains prior authorizations from third-party payers in accordance with payer requirements
• Works with other departments to gather the clinical information required by the payer to authorize services
• Maintains accurate records of authorizations within the EMR
• Works with the business office to support appeal efforts for authorization related denials
• Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality
• Maintains professional tone at all times when communicating with patients and payer representatives
• Completes approved adjustments as requested and adds charges as requested
• Keep filing updated for easy access
• Keep the waiting area orderly throughout the day
• Assist in maintaining accurate patient business records
• Orders and maintains supplies as required
• Maintains good working relationship both within the department and with other departments
• Demonstrates an ability to be flexible, organized and function well in a stressful situation
• Treat patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information
• Follows established departmental policies, procedures, and objectives. Continues quality improvement objectives and safety, environmental and/or infection control standards
• Other duties as assigned by the Patient Access Manager

Skills

• Ensures that payers are prepared to reimburse Hopedale Medical Complex for scheduled services in accordance with the payer-provider contract
• Contacts payers to request service authorizations
• Collects financial and/or demographic information from patients as needed
• Determines insurance coverage for tests/procedures and counsels patients regarding this coverage
• Performs financial counseling duties
• Verifies patient's insurance and benefits information
• Obtains prior authorizations from third-party payers in accordance with payer requirements
• Works with other departments to gather the clinical information required by the payer to authorize services
• Maintains accurate records of authorizations within the EMR
• Works with the business office to support appeal efforts for authorization related denials
• Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality
• Maintains professional tone at all times when communicating with patients and payer representatives
• Completes approved adjustments as requested and adds charges as requested
• Keeps filing updated for easy access
• Keeps the waiting area orderly throughout the day
• Assists in maintaining accurate patient business records
• Orders and maintains supplies as required
• Maintains good working relationship both within the department and with other departments
• Demonstrates an ability to be flexible, organized and function well in a stressful situation
• Treats patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information
• Follows established departmental policies, procedures, and objectives
• Continues quality improvement objectives and safety, environmental and/or infection control standards
• Other duties as assigned by the Patient Access Manager

Benefits

• Tuition Reimbursement
• Excellent benefits - health, dental, vision, and life and disability insurance
• Quality childcare located on site
• HMC Wellness Center membership
• 401(k) plan with employer match
• Employee Daycare Rates

Company Overview

Company H1B Sponsorship