PAIN & SPINE - INSURANCE PRE-AUTHORIZATION SPECIALIST

Mountain View Hospital; Idaho Falls (ID); On-site; USD 38,000 - 54,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid Time Off

Job summary

Mountain View Hospital in Idaho Falls seeks a detail-oriented Preauthorization/Billing specialist to ensure documentation supports medical necessity and secure pre-authorizations for visits and procedures. You will coordinate with referring offices and vendor representatives to submit requests, verify CPT codes, and maintain accurate outpatient billing records.

Join a mission-driven team with benefits including medical, dental and vision insurance, paid time off, retirement plans, and education

Qualifications

• High School diploma or equivalent.
• Knowledge of diagnoses and CPT codes for pain management services preferred.

Responsibilities

• Verify preauthorizations and document medical necessity with insurance.
• Coordinate with referring offices to obtain necessary paperwork for pre-authorizations.
• Submit preauthorization requests and ensure timely processing with insurers.
• Maintain accurate outpatient billing records and collaborate with co-workers and vendor representatives.

Skills

Attention to detail

Communication

Teamwork

Time management

Education

High School diploma

Job description

JOB SUMMARY

Checks appointments and tasks/messages to make sure the diagnosis/documentation will support medical necessity, as per insurance company, and verify that all office visits and procedures that need preauthorization are pre-authorized. Works closely with referring offices to be used as a resource in helping them get necessary paperwork to start pre-authorizations, prove medical necessity, or to perform a retro-authorization. Works closely with co-workers and vendor representatives to get visits/procedures approved.

About Mountain View

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice. Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day.

Benefits

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

Qualifications

Education

High School graduate or equivalent. Knowledge of diagnoses and CPT codes for pain management services preferred.

Experience

Prior experience with coding and billing for outpatient billing is preferred.

Language/Communication

Ability to communicate well with patients, co-workers and vendor representatives.

Mental Capabilities

Continuously able to concentrate on fine detail with interruptions and continuously able to attend to task/function for an extended period of time. Ability to learn computer programs and input data as required.

Interpersonal

Ability to work well with others.

Performance

Writing skills necessary to properly submit preauthorization requests with insurance companies. Appropriate phone etiquette to properly submit preauthorization requests with insurance companies. Holds the judgment, tact and diplomacy to effectively resolve conflicts.