Prior Authorization Specialist, Full Time
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At a glance
Job overview
Cabinet Peaks Medical Center is hiring a Prior Authorization Specialist, Full Time. Cabinet Peaks Medical Center seeks a team‑oriented Prior Authorization Specialist to obtain prior authorizations and pre‑certifications, coordinate scheduling, and maintain accurate records while complying with HIPAA and organizational policies.
Key focus areas include Contact insurance carriers to verify patient eligibility, benefits, and requirements., Request, track, and obtain prior authorizations from insurance carriers within allotted time., and Contact patients to gather and update demographic and insurance information in the EMR..
Successful candidates bring High School Diploma. Important skills include Strong Communication, Professional Customer Service, Insurance Knowledge, Follow Directions, Policy Compliance, and Good Judgement.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Cabinet Peaks Medical Center is seeking a team-oriented Prior Authorization Specialist to work in the Business Office!
Reporting to the Director of Revenue Cycle, this position is responsible for obtaining prior authorizations and pre-certifications for procedures and medications, coordinating the scheduling and re-scheduling with outpatient departments and patients.
Major Job Duties & Responsibilities
Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements.
Request, track and obtain prior authorization from insurance carriers within time allotted for medical and services.
Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical procedures including HIPAA regulations.
Works closely with other departments to gather the clinical information required by the payer to authorize services.
Maintains accurate records of authorizations within the EMR.
Identifies patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage (ABNs) as well as other Commercial notices similar to the ABN.
Works with business office staff 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 ton at all times when communicating with patients, payer representatives and fellow coworkers.
Performs other clerical duties assigned by Administration or Supervisor.
Adheres to the PROMISE standards and follows the AIDET practice.
Skills, Knowledge, & Abilities
Strong communications skills both verbal and written.
Professional Customer Services skills and pleasant and courteous demeanor.
Knowledge of insurances.
Ability to follow directions.
Ability to follow Federal/ State and hospital policy and guidelines.
Requires good judgement, tact, diplomacy, and ability to problem solve.
Requires effective customer relation skills both internal and external.
Strong organizational skills, including the ability to write and interpret notes.
Strong typing skills, and basic knowledge of office machines such as phones, faxes and copy machines.
Schedule
As per the needs of the department.
Educational Requirements
High School Diploma or equivalent education.
Experience
Previous experience in medical setting preferred.
Benefits Package Available.
Full Time benefits package includes medical, dental, vision, long-term disability (LTD), and life & accidental death and dismemberment (AD&D) insurance for you and your eligible family members, plus a 403(b) retirement plan with employer match.
Cabinet Peaks Medical Center is committed to providing a safe, efficient, and productive work environment for all employees. To help ensure a safe and healthful working environment, each applicant to whom an offer of employment has been made will be required as a condition of employment to undergo a substance test. Additional pre-employment items may be required. Please contact Human Resources for details.
Department
CPMC Admitting
Employment Type
FTREG
Minimum Experience
Entry-level
Compensation
$15.32-$21.45 DOE
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