Prior Authorization Specialist

Kimball Health; Nebraska; On-site; USD 38,000 - 48,000; Full time

Job summary

Kimball Health seeks a Health Information Technician to compile, maintain and support timely and accurate health information for patients. You will ensure data accessibility for authorized users and handle storage and retrieval of records.

Responsibilities include processing prior authorizations, submitting medical records, and maintaining confidentiality according to policy. A two-year associate degree in health information management is preferred; basic computer skills and accurate data entry

Qualifications

• Two-year associate degree in health information management preferred.
• High school diploma or equivalent required.
• Basic computer skills and related experience or training.

Responsibilities

• Receive requests for prior authorizations via EHR or phone/fax and monitor them.
• Process referrals and submit medical records to carriers to expedite approvals.
• Knowledge of CPT, ICD-10 and HCPCS codes.
• Manage correspondence with insurers, physicians, specialists and patients.
• Assist with medical necessity documentation to expedite approvals and follow-up.
• Review information for completeness and accuracy with supporting documents.
• Review denials and submit appeals with required information.
• Prioritize incoming authorizations by patient urgency.
• Maintain records per regulatory and facility guidelines.
• Prepare, file and scan records/documents in designated areas.
• Ensure quality and integrity of scanned data.
• Enter and retrieve data in hospital/clinic record systems for clinical/financial/statistical purposes.
• Answer calls, route messages, and assist customers promptly.
• Interact positively with patients and the public; maintain professional relationships.
• Attend approved committees and meetings; participate as requested.
• Maintain knowledge through in-services, workshops, and seminars.
• Demonstrate flexibility with workload variations.
• Maintain confidentiality of all patient and facility information.

Skills

Typing

Data entry

Organizational skills

Interpersonal communication

Medical record knowledge

Attention to detail

Education

Associate degree in health information management

HS diploma or equivalent

Tools

EHR software

Job description

Description

SUMMARY

Compile, maintain and support timely and accurate completion of the health information of patients at KHS, Making information available to authorized users timely. Maintain storage and retrieval of health information. Assist in monitoring and resolving deficiencies, accurate data entry for clinical, financial and statistical purposes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To be carried out in accordance with KHS and regulatory entities policies and procedures including, but not limited to, the following:

• Receive requests for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Knowledge of CPT, ICD-10 and HCPCS codes.
• Manage correspondence with insurance companies, physicians, specialist and patients as needed, including documenting in the EHR as appropriate.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
• Prioritize the incoming authorizations by level of urgency to the patient
• Maintain records according to regulatory and facility guidelines.
• Prepare, file and or scan records/documents in designated areas according to applicable filing/scanning system.
• Ensure quality and integrity of scanned data
• Operates computer and department software to enter and retrieve data and create correspondence and or reports.
• Responsible for data entry into hospital, clinic and other record systems for clinical, financial, and statistical purposes
• Answer telephone, route calls, take messages, and provide assistance and guidance to customers promptly and courteously
• Interact positively with patients and public
• Maintain Constructive Relationships with all internal and external customers
• Attends and participates in approved/requested committees and meetings.
• Maintains current knowledge and skills through in-services, workshops, and/or seminars.
• Demonstrates flexibility in adjusting to variable workloads and job duties.
• Maintain confidentiality of all patients, clients and facility information at all times.
• Any other duties as assigned.

Requirements

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

A two-year associate degree in health information management is preferred. Must have basic computer skills. Must possess high school diploma or its equivalent. One year of related experience and/or training; or equivalent combination of education and experience.

SKILLS

Typing and computer skills, strong organizational skills, detail oriented, excellent interpersonal/communication skills, basic knowledge of medical record content. Must be able to process work meeting acceptable benchmarks and deadlines/timeframes. Ability to effectively present information and respond to questions from supervisors, patients, patient's family, other employees of the organization and the general public.

REASONING ABILITY

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Light physical effort: ability to lift or carry up to 10 pounds regularly
• Mostly sedentary work
• Occasional standing and walking
• Ability to communicate verbally
• Close vision and distance vision.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is exposed to hazards from electrical/mechanical/power equipment. Uses computer equipment extensively. The noise level in the work environment is usually quiet. May occasionally require irregular hours.