Skilled Nursing Prior Authorization Specialist- weekends required

Guided Care is seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. Ideal candidates should have Skilled Nursing Admissions experience, or SNF Business Office Management experience.

• MUST be willing to work a Thursday-Monday or a Wednesday-Sunday schedule (includes every weekend), covering clients in the Central time Zone (9am-5pm Central).

Experience with Availity, UHCLINK, as well as other portals required. Candidates should have prior experience working remotely, and be proficient with Microsoft Office, and be adaptable and able to quickly learn other programs related to the role. Must be able to handle a high volume and work in a fast paced, sometimes stressful environment. · Puts forth best efforts to learn and understand the full training provided upon onboarding. · Actively responds to clients’ authorization requests within 20 minutes of receipt per each request throughout the day. · Maintains a full understanding and data input accuracy of Guided Care software for managing client authorization requests. · Maintain a high level of customer service and professionalism in all methods of communication.

• Completes an average of 180 authorizations per 30 days at 90 days of hire.
• Completes an average of 200 authorization per 30 days at 120 days of hire.
• Completes an average of 220 authorization per 30 days at 150 days of hire.
• Maintains an error rate of less than 2 per month after 90 days of hire.

· Complete census verification before or by 11 AM. Communicates with clinical case manager as required. · Updates supervisor of any new developments on prior auth process specific to health plans and states to ensure upkeep the Guide to Obtain Authorizations. · Requests authorizations within 20 minutes of client requests and provides updates to clients minimum three times a day on pending cases. · Informs supervisor of prior authorizations pending over 72 hours to assist in escalation and client satisfaction. · Reviews prior auth packet for completeness and is responsible for ensuring correct documentation is submitted to insurance. Is responsible for ensuring only clinical documentation required by insurance is submitted. · Provide feedback to the supervisor on 1:1 monthly meeting or immediately as necessary if client is not following the guided care prior auth request process. · Upkeep skilled active listing to ensure a smooth and organized workflow. · Responsible for updating coverage notes to ensure smooth coverage of caseload. · Provide support and education to clients on prior authorization process and software usage as needed. · Review monthly AR logs prior to the 1st of every month to ensure data is entered accurately for appropriate billing. · Coordinate and submit all prior auth appeal requests. Follow up with appeals team timely to ensure appeals are being completed by deadline. · Collaborates with colleagues, helping and handling additional cases during downtime or a lull in individual caseload. Job Type: Full-time Pay: $55,000.00 - $62,000.00 per year Benefits:

• Dental insurance
• Health insurance
• Paid time off

Application Question(s):

• Are you able to commit to either a full time TH-Mon or Wed-Sun schedule (every weekend required)?

Experience:

• Skilled Nursing Prior Auth: 2 years (Preferred)

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