Patient Access & Authorization Specialist

Pioneers Medical Center; Colorado; On-site; USD 27,552 - 31,684; Full time

Job summary

Pioneers Medical Center is seeking a healthcare Revenue Cycle Professional to handle pre-authorizations for imaging, verify insurance details, and advise patients of financial responsibilities. You will collaborate with clinical teams, submit requests via multiple channels, and troubleshoot the authorization system.

Responsibilities include processing requests accurately, handling denials, maintaining confidentiality, and cross-training in registration and discharge processes.

Qualifications

• High school diploma or equivalent required.
• Revenue Cycle courses and continuing education as provided.
• Annual Medicare Fraud and Abuse Education.
• Medicare Secondary Payer documentation.
• Certification as a Revenue Cycle Specialist through AAHAM or as CRCR through HFMA is desired within two years.
• Current BLS required within six months of transfer or hire.
• Knowledge of medical billing practices, including ICD-10, CPT, and HCPCS codes desirable.

Responsibilities

• Obtains pre-authorizations for imaging.
• Reviews information regarding insurance eligibility, deductibles, coinsurance, and/or copays for patients.
• Informs patients of their financial responsibility either via phone or mail.
• Works closely with clinical team to obtain various clinical documents to complete the pre-authorization process.
• Submits requests via insurance portal, fax, or phone.
• Communicates denials to appropriate provider or department.
• Completes requests accurately and timely to ensure quality patient care.
• Understands the Athena/Meditech Authorization Management tool and is able to troubleshoot issues.
• Will cross-train extensively in the areas of hospital and clinic registration and discharge.
• May be required to obtain pre-certification information on hospital and swing bed admits.
• May be required to review and complete Emergency Department registrations.
• Documents appropriate information on accounts on which action has taken place.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Conducts self in accordance with PMC’s employee manual.
• Makes suggestions and helps with continuous quality improvement in all department processes.
• Maintains up-to-date guidelines to ensure responsibilities of the essential job functions are adequately outlined for training purposes. Manuals are to be easily identified and readily available.
• Participates in educational activities, staff meetings, and in-services as required
• Other duties as assigned.

Skills

Pre-Authorization

Insurance verification

Billing knowledge

HIPAA compliance

Education

High school diploma

BLS certification

Revenue Cycle Certification (AAHAM/HFMA)

Job description

Pioneers Medical Center is seeking a healthcare Revenue Cycle Professional to handle pre-authorizations for imaging, verify insurance details, and advise patients of financial responsibilities. You will collaborate with clinical teams, submit requests via multiple channels, and troubleshoot the authorization system.

Responsibilities include processing requests accurately, handling denials, maintaining confidentiality, and cross-training in registration and discharge processes.