Prior Authorization Specialist I – Fast-Paced Healthcare

Rush University Medical Center; Chicago (IL); On-site; USD 26,000 - 37,000; Full time

Job summary

Rush University Medical Center is seeking a Prior Authorization Specialist I to support patients, providers, and the revenue cycle by obtaining insurance authorizations and ensuring services meet payer requirements before care is delivered.

In this role, you will verify insurance coverage, secure referrals and prior authorizations, gather required clinical and demographic information, and collaborate with patients, providers, and insurance carriers to support timely access to care.

Qualifications

• High school graduate or equivalent.
• 0-1 year of experience.
• Basic MS Office understanding.
• Excellent communication and outstanding customer service and listing skills.
• Basic keyboarding skills
• Ability to analyze and interpret data.
• Critical thinking, sound judgment and strong problem-solving skills essential.
• Team oriented, open minded, flexible, and willing to learn.
• Strong attention to detail and accuracy required.
• Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
• Ability to follow oral and written instructions and established procedures.
• Ability to function independently and manage own time and work tasks.
• Ability to maintain accuracy and consistency.
• Ability to maintain confidentiality.

Responsibilities

• Reviews, collects and properly records demographic and insurance information required to properly address the customers' authorization requirements and identify any financial issues.
• Verifies patient’s eligibility from resources provided by third party payers and portals and other on lines services.
• Collects and analyzes demographic, insurance and other information from the patient, guarantor and all other sources to accurately obtain authorization for scheduled procedure.
• Assembles information concerning the patient’s clinical background and clinical information that is required for the payer to issue a referral or an authorization.
• Contact review organizations and insurance companies to ensure prior approval requirements are met.
• Present necessary medical information such as history, diagnosis, CPT codes and clinical notes.
• Provide specific medical information to financial services to maximize reimbursement to the hospital and professional service providers.
• Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy and security Regulations, as well as JACHO.
• Consistently maintains authorization accuracy rates at and or above department standard in performance of registration and authorization duties.
• Customers. Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
• Interacts and collaborates with numerous departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
• Appropriately informs the patients of hospital policies that govern the revenue cycle, the amount owed by the patients and explains hospital payment policy.
• Offers option of Financial Counselors to assist in acceptable resolution of estimated patient balance.
• Receives and properly responds to, or directs telephone and electronic inquiries from patients, payers, physicians and their staff, internal department and other persons and entities.
• Ability to exercise good customer service skills when communicating with both our patients as well as our internal customers.
• Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to elevate to their supervisor.
• Performs other duties as assigned for the operational effectiveness and success of the department.
• Interacts and collaborates with numerous departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Rush University Medical Center’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Guards to assure that HIPAA confidential medical information is protected
• Attends regular EPIC training sessions or other sessions conducted for the benefit of associates involved in the Financial Counseling functions.
• Other duties as needed and assigned by the supervisor/manager.

Skills

Microsoft Office

Communication

Customer service

Data analysis

HIPAA knowledge

Time management

Education

Associates Degree in Accounting or Business Admin

Tools

EPIC

Job description

Rush University Medical Center is seeking a Prior Authorization Specialist I to support patients, providers, and the revenue cycle by obtaining insurance authorizations and ensuring services meet payer requirements before care is delivered.

In this role, you will verify insurance coverage, secure referrals and prior authorizations, gather required clinical and demographic information, and collaborate with patients, providers, and insurance carriers to support timely access to care.