Prior Authorization Clinician II - 40 hours per week - Patient Access

Great River Health; West Burlington (IA); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider in West Burlington is seeking a Prior Authorization Clinician II to ensure efficient patient access to care and manage prior authorization processes. This role requires a registered nurse with strong organizational skills and clinical knowledge to maintain compliance and excellent service.

Benefits

Competitive base pay

Matching retirement programs

Health, Dental, and Vision plans

Paid time off (PTO)

Education Assistance Program

Employee Referral Bonus Program

Discounted cafeteria meals

Qualifications

• 1-3 years healthcare experience in hospital or provider office required.
• Proficient in using EMR systems and scheduling software.
• Ability to manage multiple tasks in a fast-paced healthcare environment.

Responsibilities

• Coordinate prior authorization process to ensure efficient patient care.
• Manage patient data and ensure compliance with regulations.
• Communicate with patients and insurance providers about authorization status.

Skills

Clinical Knowledge

Communication Skills

Customer Service

Attention to Detail

Problem-Solving

Organizational Skills

Education

Associate's Degree

Current Registered Nurse (RN) license

Tools

Electronic Medical Record (EMR) systems

Microsoft Office Suite

Job description

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Prior Authorization Clinician II | 40 hours per week | Patient Access

Great River Health Systems | West Burlington , IA 52655

Scheduled Hours: Monday - Friday, 8:00am - 4:30pm

Job Description

A Brief Overview

The Prior Authorization Clinician coordinates and manages the prior authorization process to ensure efficient and timely patient care while optimizing resource utilization. This role involves reviewing clinical documentation, verifying insurance benefits, verifying and obtaining prior authorizations for medical services, and coordinating with clinical teams to streamline patient access to care. Responsibilities include accurately managing patient data, ensuring compliance with all state and federal regulations, and maintaining effective communication with patients, insurance providers, and healthcare staff. The Clinician is responsible for addressing inquiries or concerns related to prior authorizations, maintaining detailed records of authorization status, and monitoring and updating authorization requirements as needed. This role requires proficient clinical knowledge, organizational skills, attention to detail, effective communication, and the ability to manage multiple tasks in a fast-paced healthcare environment while delivering exceptional service.

What you will do

• Review clinical documentation to determine medical necessity and verify and obtain appropriate prior authorizations.
• Verify insurance benefits and work directly with insurance providers to secure prior authorizations for medical services.
• Coordinate with healthcare teams to ensure timely submission of authorization requests and minimize delays in patient care and maintain detailed and accurate records of all prior authorization requests, approvals, denials, and follow-ups.
• Schedule patient appointments and pre-register and register patients efficiently and accurately, collecting all necessary personal and medical information, when needed.
• Communicate effectively with patients, clinical staff, and insurance representatives to provide updates on authorization status.
• Ensure compliance with all state and federal regulations, including patient privacy and data security standards.
• Manage patient data with accuracy, ensuring all documentation is complete and up to date.
• Respond promptly to inquiries or concerns related to prior authorizations, resolving issues or escalating when necessary.
• Collaborate with clinical teams to review and interpret medical information needed for authorizations.
• Monitor and update knowledge of insurance policies, authorization criteria, and payer requirements and educate patients and healthcare staff on authorization processes and requirements when needed.
• Collect and process payments, including co-pays and outstanding balances, in a timely and accurate manner, when needed.
• Handle a high volume of authorization requests while maintaining efficiency and attention to detail.
• Analyze and improve authorization work flows to optimize resource utilization and reduce turnaround times.
• Identify and address any issues that may delay patient care, proactively finding solutions.
• Stay informed on changes to insurance policies and procedures, updating work flows as necessary.
• Assist with appeals processes when authorizations are denied, providing necessary clinical information and support.
• Participate in training sessions and continuous education to maintain clinical and regulatory knowledge.
• Verify provider orders to ensure all requirements are met, including accuracy, completeness, and compliance with organizational policies and external regulations. Confirm and validate orders from outside providers (Conversion Physicians) to ensure proper documentation and authorization.
• Verify insurance benefits and eligibility to facilitate smooth billing and claims processing.
• Uphold the organization's standards for patient care and satisfaction through diligent, high-quality work.

Qualifications

Qualifications

• Associate's Degree (AA) Current and active Registered Nurse (RN) license in good standing Required
• 1-3 years Healthcare experience in hospital or provider office Required
• Clinical Knowledge: Proficient clinical background and ability to interpret medical information relevant to prior authorizations.
• Technical Skills: Proficiency in using electronic medical record (EMR) systems and scheduling software.
• Communication Skills: Excellent verbal and written communication skills, with the ability to interact professionally with patients, staff, and healthcare providers.
• Customer Service: Proficient commitment to providing high-quality customer service and ensuring a positive patient experience.
• Organizational Skills: Exceptional organizational and time management skills, with the ability to prioritize and handle multiple tasks in a fast-paced environment.
• Attention to Detail: High level of accuracy and attention to detail when handling patient information and scheduling.
• Problem-Solving: Ability to identify and resolve conflicts and other issues efficiently.
• Interpersonal Skills: Ability to work collaboratively as part of a healthcare team and maintain a professional and courteous demeanor.
• Regulatory Knowledge: Familiarity with HIPAA regulations and other healthcare privacy and security requirements.
• Insurance Knowledge: Understanding of insurance verification processes, good faith estimates, and prior authorizations.
• Adaptability: Flexibility to adapt to changes in scheduling needs and department priorities.
• Computer Proficiency: Competence with Microsoft Office Suite (Word, Excel, Outlook) and general computerskills.
• Multitasking: Ability to manage a high volume of requests and administrative tasks simultaneously.
• Emotional Intelligence: Demonstrated ability to handle sensitive and confidential information with discretion.
• Work Ethic: Reliable, punctual, and committed to maintaining a high standard of work.
• Registered Nurse Iowa Board of Nursing (IBON) (United States of America) Upon Hire Required

We are excited to offer an aggressive compensation and benefits package for qualifying positions, which includes:

Competitive base pay

Matching retirement programs

Health, Dental and Vision plans

Health Savings and Flexible Spending Accounts

Employee discounts including car rental, cell-phone plans

Employer-paid, Long-Term Disability, Life, and AD&D

Paid time off (PTO)

Education Assistance Program

Employee Assistance Program

Employee Referral Bonus Program

Discounted cafeteria meals

Employee Service Recognition program

Voluntary plans including: Life, AD&D, Short-Term Disability, Critical Illness, Accident, Insurance, and Hospital Indemnity

Great River Health and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.