Authorization Specialist

Park Nicollet Methodist Hospital; Saint Paul (MN); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Retirement program

Tuition reimbursement

Employee assistance program

Job summary

Park Nicollet Methodist Hospital is hiring an Authorization Specialist to create hospital encounters for surgical services at Ambulatory Surgery Centers and the main hospital. You will verify insurance coverage and obtain and document prior authorization approvals for procedures and inpatient stays.

In collaboration with the Care Team, you will submit clinical documentation for payer review, maintain payer authorization records, and stay current with changes in pre-certification and notification

Qualifications

• High school diploma or equivalent required.
• Experience with Epic EMR and insurance prior authorizations.
• Knowledge of patient eligibility and hospital billing cycle.

Responsibilities

• Create hospital encounters for surgical services at ambulatory centers and Park Nicollet Methodist Hospital.
• Verify insurance coverage and obtain prior authorizations for procedures and hospital stays.
• Submit clinical documentation for payer review and maintain payer requirements.
• Attend training and stay current with changes in pre-certification and notification requirements.
• Support cash flow and patient satisfaction through accurate authorizations.

Skills

PC keyboard

Customer service

Written/verbal communication

Critical thinking

Patient eligibility knowledge

Billing cycle knowledge

Time management

Problem-solving

Insurance selection knowledge

Microsoft Office

Office equipment basics

Education

High school diploma or equivalent

Post high school degree or certification

Tools

Epic

Microsoft Office

Job description

Position Summary:

Park Nicollet is looking to hire an Authorization Specialist to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.

The Authorization Specialist is responsible for creating hospital encounters for surgical services throughout Park Nicollet Ambulatory Surgery Centers and Methodist Hospital. This position is responsible for completing insurance verification, obtaining and documenting prior authorization approvals from insurance companies for procedures and hospital stays.

In collaboration with the Care Team, the Authorization Specialist will obtain and submit clinical documentation pertinent to the specific services requiring authorization for payer review.

The Authorization Specialist will maintain and update documentation as it relates to changes in payer prior-authorization, pre-certification and notification requirements by reviewing insurance payer bulletins and publications.

This position must attend continuing education classes and complete mandatory training in order to maintain department specific requirements and professional growth. Effective performance of these functions helps the organization achieve strong cash flow and maximize patient's satisfaction.

Required Qualifications:

Education, Experience or Equivalent Combination:

• High school diploma or equivalent

Knowledge, Skills, and Abilities:

• Demonstrated P/C and keyboard experience.
• Demonstrated customer service skills.
• Demonstrated written/verbal communication skills.
• Knowledge of EPIC registration and/or any electronic health record
• Ability to work cohesively and respectfully with a diverse work force and patient population.
• Ability to utilize critical thinking skills while working through complex situations
• Knowledge of patient eligibility and related systems
• General knowledge of hospital billing cycle
• Demonstrates effective time management skills and problem-solving skills
• Communicates effectively and maintains composure under stressful situations
• Ability and expectation to successfully complete a competency examination on insurance selection/process upon completion of training and annually thereafter.
• Ability and expectation to demonstrate competency on insurance selection/process on a monthly basis.
• Proficiency with Epic, personal computers with word processing, spreadsheets and email.
• Preference for experience with the Microsoft Suite (e.g. Word, Excel, Outlook).
• Working knowledge of typical office equipment is expected.

Preferred Qualifications:

Education, Experience or Equivalent Combination:

• Post high school degree or certification.
• Healthcare registration experience.
• Healthcare revenue cycle experience.

Knowledge, Skills, and Abilities:

• 2 years previous healthcare experience which may include medical terminology, insurance eligibility, prior authorizations, but not limited to ICD/CPT coding experience.

Benefits:

Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, onsite clinic and much more!