Prior Authorization Specialist

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  The Prior Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Cuyuna Regional Medical Center for scheduled services in accordance with the payer-provider contract. The Prior Authorization Specialist contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed.
  
  

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  Education and Experience:
  
  
  
  
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    Associates degree in healthcare or business administration and/or related coursework, or comparable experience of a minimum of 2 years in a related healthcare field (i.e. coding, nursing and/or billing). Must have excellent customer service and communication skills. Successful completion of data entry, general clerical, and ten key administered by Cuyuna Regional Medical Center Human Resources staff.
    
    
  
  
  
  
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  License/Certificates:
  
  
  
  
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    N/A.
    
    
  
  
  
  
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  Special Skills and Aptitudes:
  
  
  
  
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    • Familiarity with medical terminology and healthcare insurance processes.
    • Ability to work independently with strong attention to detail.
    • Ability to prioritize and multitask.
    • Ability to perform routine and complex procedures.
    • Ability to recognize problems, identify the cause and implement solution.
    • Ability to deal with others in a courteous and tactful manner.
    
    
    
    
  
  
  
  

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  1. Verify patients' insurance and benefit information.
  2. Obtains prior authorization and inpatient notification from third-party payers in accordance with payer requirements.
  3. Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
  4. Works with other departments to gather the clinical information required by the payer to authorize services.
  5. Mentions accurate records of authorizations within the EMR.
  6. Identifies patients who will need to receive Medicare Advantage Beneficiary Notices of Non-coverages (ABNs).
  7. Communicates with scheduling staff after prior authorization is obtained.
  8. Works with patients if financial counseling is needed, if authorization is not obtained.
  9. Works with business office staff to support appeal efforts for authorization-related denials.
  10. Complies with HIPPA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.
  11. Maintains professional tone at all times when communicating with patients, payers representatives and physicians.
  12. Demonstrate Standards of Excellence when other duties are assigned.
  
  
  
  
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  Lead Responsibilities if applicable:

  
  

  
  
  • Direct and check the work of others.
  • Participate in the orientation and/or training of employees and provide feedback to management.
  • Coordinate the workflow among employees within the work area.
  • Provide technical or functional directions and support to employees.
  • Inform management on operational needs of the department.
  • Assist with the creation of work schedules.
  • Approve requests for time off, schedule changes, or additional ours/overtime and determine sick call replacement, according to a jointly pre-approved process, in the absence of a supervisor or manager.
  • Excellent Customer Service and communication skills are essential for the lead position.
  • Analyze and monitor all assigned work queues, identify error trends and develop training resources to improve accuracy.
  • Work closely with all Revenue Cycle staff to identify and create account accuracy improvement projects.
  • Serve as a communication liaison between revenue cycle staff for problem accounts and efficiencies.
  
  

  
  
  

  The pay range for this role is $19.01 to $28.53.

  Benefits
  
  Flexible schedule
  
  Competitive wages
  
  Medical, Dental, Vision, & Life insurance options
  
  HSA option
  
  401k contribution
  
  Scheduled every other weekend
  
  Paid Time Off

  
  

Why Cuyuna Regional Medical Center? CRMC provides the highest quality patient care by hiring exceptional, qualified individuals and providing opportunities for growth and advancement. We are more than 1,000 employees working in a unique environment that brings together the best in patient care and innovative medical specialties. From our expansive surgery suites with leading edge technology to our resort inspired senior living spaces, from trauma to routine, obstetrics to hospice, we provide services across the continuum of care - all in Minnesota's beautiful Brainerd lakes country. For more information about our medical campus visit: http://www.cuyunamed.org.

We offer a competitive compensation package, which includes exceptional benefits.

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Site Description: Crosby a city of 3,000 residents is part of the Brainerd and Cuyuna Lakes Area in central Minnesota. It is a top 5 destination in the United States for mountain biking. Crosby is just 15 miles from Brainerd, MN and a two-hour drive from Minneapolis/St. Paul. The Brainerd Regional Airport, which is serviced daily by Delta Airlines, is located 11 miles from Crosby. CRMC is located within a two-hour radius of Alexandria, Duluth, and St. Cloud.