PFS Prior Authorization Specialist789-06

Box Butte General Hospital; Alliance (NE); On-site; USD 32,000 - 42,000; Full time

Job summary

Box Butte General Hospital is seeking a PFS Prior Authorization Specialist to verify insurance coverage, pre-certification, and pre-authorization requirements for inpatient, observation, and outpatient services. The role involves coordinating with Utilization Review and Surgery departments to ensure timely pre-certification and maintaining positive patient relations.

Essential duties include contacting insurance companies, gathering demographic data, and documenting eligibility and authorization

Qualifications

• Proficient computer skills and keyboarding speed.
• Experience using telephone for customer information gathering preferred.
• Attention to detail and ability to navigate multiple systems.

Responsibilities

• Verify insurance coverage, pre-certification and/or pre-authorization requirements for inpatient, 23-hour observation and outpatient services.
• Coordinate with Utilization Review, Surgery and other departments to meet pre-certification requirements.
• Contact insurance companies to verify coverage and benefits for patients.

Skills

Computer Skills

Keyboarding

Telephone experience

Education

High school diploma

Job description

PFS Prior Authorization Specialist789-06 FEATURED

PATIENT FINANCE

FT , Day Shift

High School/GED

Title: PFS Prior Authorization Specialist

General Summary of Responsibilities : To verify insurance coverage, pre-certification and/or pre-authorization requirements for Inpatient, Outpatient Observation and outpatient services patients. To coordinate activities with the Utilization Review, Surgery and other departments to assure pre-certification requirements are met. All communications are conducted in a manner that will result in positive patient relations.

Essential Job Responsibilities:

• Coordinates activities with hospital departments to assist in meeting pre-certification or pre-authorization requirements for inpatients, 23 hour observation and surgery patients.
• Communicates with the Outpatient Surgery and the Multi-Specialty Clinic departments to access schedules and assist in meeting insurance pre-certification requirements for patients on the surgery schedule.
• Coordinate activities with Utilization Review staff to verify insurance eligibility and coordinate activities related to pre-certification requirements of Inpatients and 23-hour observation patients.
• Contacts patient’s insurance company to verify coverage & benefits for inpatients, observation patients and surgery patients.
• Contact the patient or his/her representative by phone to gather demographic and insurance information prior to the surgery date.
• Contact insurance companies via internet and/or phone to verify insurance eligibility and document coverage and benefits.
• Access the Medicare Common Working File to verify Medicare coverage, eligibility dates and other insurance coverage.
• Enters patient demographic and insurance information in the Meditech EMRsystem efficiently and accurately.
• Document information relating to insurance eligibility, pre-certification and/or pre-authorization information or confirmation numbers.
• Follows up on insurance non-payment claims relating to pre-cert or pre-authorization requirements.
• Handles phone, mail and personal inquiries from and regarding patient accounts.
• Assists each person promptly, efficiently and courteously.
• Follow through on all issues identified as requiring action as a result of inquiry.
• Document all phone and personal inquiries in the Meditech EMR system.
• Performs duties with a minimum of supervision, exhibits innovation and good judgment.

Other Job Functions:

• Provides back-up for the PBX during vacancies and absences. Enhances professional development by taking steps to remain knowledgeable of industry standards, and attending meetings and seminars as assigned.
• Actively participates in BBGH Performance Improvement activities. Attends a minimum of 80% of mandatory staff meetings.
• Contributes to the prevention of infectious disease among employees and patients by adhering to infection control policies and procedures.
• Contributes to adequate staffing of department by reporting to work at scheduled time.
• Contributes to effective guest relations by assisting patients, visitors and physicians to resolve expressed concerns and demonstrating a welcoming and helpful attitude.
• Conserves hospital resources by using equipment and supplies as needed to perform job duties.
• Keeps information confidential by adhering to the terms of personnel policy concerning confidentiality.
• Maintains a clean and calm environment. Completes all required paperwork/computer entry for each patient needed.
• Follow the Standards of Behavior. Utilize TeamSTEPPS tools.
• Participate in Patient Experience.
• Regular attendance essential. Performs other related duties as assigned or requested.

Job Qualifications:

• Age Requirement
• Required: Must be 19 years or older
• Education:
• Required: High school diploma, or equivalent.
• Experience:
• Required: Computer Skills/Keyboarding
• Preferred: Previous experience in use of telephone to gather customer information.
• License/Certification
• Required:
• Preferred: Certified Patient Accounts Technician (CPAT) Certification

Box Butte GeneralHospital is an Equal Opportunity Employer.

Post-offer/pre-employment background check and drug screen are required.