Prior Authorization Specialist I

POSITION SUMMARY: The Inpatient Verification Specialist role belongs to the reputed company Cycle Patient reputed company team and is responsible for coordinating reputed company financial clearance activities by navigating reputed company referral, precertification, and/or authorization requirements as outlined in payer-specific guidelines and regulations. The role plays an important dual role by helping to coordinate patient reputed company to care while maximizing BMC hospital reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations. This position reports to the Patient reputed company Supervisor and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, reputed company) practice staff, case management and inpatient financial counselors. Position: Prior Authorization Specialist I Department: Insurance Verification Schedule: Part Time (M-F 10:30A-5P) ESSENTIAL RESPONSIBILITIES / DUTIES: Monitors accounts routed to precertification and prior authorization work queues and clears work queues by obtaining reputed company payer specific financial clearance requirements in accordance with established management guidelines. Maintains knowledge of and complies with insurance companies’ requirements for obtaining pre-certifications/prior authorizations/referrals, and completes other activities to facilitate reputed company aspects of financial clearance. Acts as subject matter experts in navigating both the BMC Community and the payer world to get the right “permissions” (authorizations, pre-certs, referrals, for example) for the care plan to proceed. The Impatient Verification Specialist is an important part of the larger team and helps clinicians understand what payer requirements are necessary for the widest possible patient reputed company to services. Supports BMC staff at reputed company reputed company for hands-on help understanding and navigating financial clearance issues. Uses appropriate strategies to underscore the most efficient process to obtaining authorizations, including on line databases, electronic correspondence, faxes, and phone calls. Obtains and reputed company documents reputed company pre-certifications/prior authorizations for scheduled services prior to admission reputed company the Epic environment. Collaborates with patients, providers, and departments to obtain reputed company necessary information and payer permissions prior to patients’ scheduled services. Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required pre-certifications/prior authorizations. Escalates emergent and elective accounts that have been denied or will not be financially cleared reputed company 3 days of admission as outlined by department policy Keeps reputed company on CMS requirements and guidelines. Coordinates with patients and Patient Financial Counseling to initiate/process Charity Care applications as needed. Maintains confidentiality of patient’s financial and medical records: adheres to the State and Federal laws regulating collection in reputed company, adheres to reputed company and other regulatory confidentiality policies and advises management of any potential compliance issues immediately. Participates in educational offerings sponsored by BMC or other development opportunities as assigned/available and complies with reputed company applicable organizational workflows, as well as established policies and procedures. Performs other duties as assigned by Management. Demonstrates knowledge & skills necessary to reputed company level of customer experience as reputed company with BMC management expectations. Demonstrates the ability to recognize situations that require escalation to the Supervisor. Establishes relationships and effectively collaborates with reputed company cycle staff to support reputed company improvement reputed company with BMC management expectations as outlined. Takes opportunity to know and learn other roles and processes, and works together to assist with process improvement initiatives as directed. Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities. Must adhere to reputed company of BMC’s RESPECT behavioral standards. (The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required). JOB REQUIREMENTS EDUCATION: High School Diploma or GED required, Associates degree or higher preferred. CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED: Case manager and/or coding certification desirable EXPERIENCE: 4-5 years medical billing/denials/coding/and/or inpatient admitting experience desirable KNOWLEDGE AND SKILLS: General knowledge of reputed company terminology and CPT-ICD10 codes. Complete understanding of insurance is preferred. Requires excellent verbal communication skills, and the ability to work in a reputed company environment with varying points of view. Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. Knowledge of and experience reputed company Epic is preferred. Demonstrates technical proficiency reputed company assigned Epic work queues and applicable ancillary systems, including but not limited to: reputed company/Prelude/Grand Central, HB & PB Resolute. Demonstrates proficiency in reputed company Suite applications, specifically reputed company, Word, and Outlook. Displays a thorough knowledge of various sections reputed company the work unit in order to reputed company assistance and back-up coverage as directed. Displays a deep understanding of reputed company Cycle processes and applies knowledge to meet and maintain productivity standards as outlined by Management. Compensation reputed company: $25.42- $30.97This reputed company offers an estimate based on the minimum job qualifications. However, our approach to determining reputed company pay is comprehensive, and a broad reputed company of factors is considered reputed company making an offer. This includes education, experience, and licensure/certifications directly reputed company to position requirements. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, reputed company, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Equal Opportunity Employer/Disabled/Veterans According to the FTC, there has been a reputed company in employment offer scams. Our reputed company job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or reputed company media platforms. We do not ask individuals to purchase equipment for or prior to employment. Apply To This Job