Prior Authorization Specialist

Overview

River View Health, is a community owned, membership based non-profit organization that was formed in 1898 and continues to be the sole community hospital in Crookston, MN.

River View Health operates a 25 bed Critical Access Hospital, River View Recovery Center; a chemical dependency outpatient treatment program, River View Home Care and five primary care and specialty clinics in the hospitals service area.

We have a robust scholarship program for those furthering their education in a medical field, excellent benefits, and a friendly work environment. Full-time benefits include health insurance, free single vision and basic dental insurance, life insurance, long-term disability and short-term disability, and employer HSA contributions. Other benefits include employer pension matching, shift differential, incentive/premium pay, free annual biometric screening and paid volunteer time off.

River View is an Equal Employment Opportunity employer.

Prior Authorization Specialist - Temp

Schedule:

Temp/Part-time (.5) - 40 hours per pay period

Scheduled

Hours:

Monday-Friday

Pay Range: $20.53 - $28.74 / hour (based on experience)

Job Status:
Non-Exempt/Hourly, non-benefitted

This is a temporary part-time position for an individual to fill this role immediately through the end of March, with the possibility of extension based on our business needs. The prior authorization representative is under the direct supervision of the Director of Patient Financial Services. They are responsible for ensuring that payers are prepared to reimburse River View Health for scheduled services in accordance with the payer-provider contract.

The prior authorization representative contacts payers to request service authorizations and may collect financial and/or demographic information from patients as needed.

Primary Responsibilities

• Verifies patients’ demographic, insurance, and benefits information
• Obtains pre-authorization and pre-certifications from third-party payers in accordance with payer requirements, and documents the authorization number and period of validity in the EMR system (EPIC)
• Gathers additional medical records from other providers as needed to support medical necessity when obtaining a pre-authorization, and follows up with payers on pre-authorization requests as needed
• Alerts the clinicians involved in the patient’s care when there are issues with referrals or complications with insurance coverage
• Maintains accurate records of authorizations within the EMR system (EPIC)
• Identifies patients who will need to received Medicare Advance Beneficiary Notices of Noncoverage (ABNs)
• Refers accounts to financial counseling as needed if authorization is not obtained
• 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 tone at all times when communicating with patients and payer representatives
• Performs other duties as requested

Education/Certifications/Licenses

Required:

• High school diploma or equivalent.
• 1 year Prior Authorization work
• Experience with EPIC EMR system

Preferred:

• Associate’s degree in healthcare or business administration and/or related/comparable experience preferred

Skills and

Competencies:

• Working knowledge of computers, excellent communication and organization skills
• Ability to work effectively in a team environment.
• Ability to work with little supervision and maintain a high level of performance
• Excellent organizational skills and attention to detail.
• Strong communication and interpersonal skills.