What are the responsibilities and job description for the Prior Authorization Specialist I, Full time position at Community Hospital, Colorado?
Job Description:
- Position: Prior Authorization Specialist I
- Schedule: Monday - Friday 0900-1730
Responsibilities:
- Gather Patient Information: Collect and review patient medical records, diagnosis codes, and procedure details to support the pre-authorization request.
- Verify Insurance Coverage: Confirm patient information and insurance coverage through verifying photo ID, insurance cards, and personal information.
- Submit Pre-Authorization Requests: Prepare and submit pre-authorization requests to insurance companies, adhering to their specific procedures and requirements.
- Follow Up: Monitor the progress of pre-authorization requests and follow up with insurance providers to expedite the approval process.
- Communicate with Healthcare Providers: Collaborate with healthcare providers to obtain any necessary documentation, notes, or additional information required for pre-authorization.
- Patient Education: Explain the pre-authorization process to patients, including potential out-of-pocket costs, and address any questions or concerns they may have.
- Document and Recordkeeping: Maintain detailed records of pre-authorization requests, approvals, denials, and communications with insurance companies and healthcare providers.
- Compliance: Ensure that all pre-authorization processes comply with relevant laws and regulations, including HIPAA (Health Insurance Portability and Accountability Act).
- Appeals: If a pre-authorization request is denied, assist in the appeals process by providing necessary documentation and information to support the appeal
Requirements:
High school diploma or equivalent.
Knowledge of medical terminology preferred.
Compensation:
- $19.00 - $21.85 per hour, depending on education and experience.
- Discretionary bonuses, relocation expenses, merit increase, market adjustments, recognition bonuses, and other forms of discretionary compensation may be available.
Benefits: (FT/PT)
- Medical, dental, vision insurance.
- Paid time off.
- Education assistance.
- 403(b) with employer matching.
- Additional benefits based on employment status.
Additional Information:
- Job Type: Full-Time
- Benefits: 403(b), 403(b) matching, dental insurance, health insurance, life insurance,
- paid time off, vision insurance.
- Relocation: Must relocate to Grand Junction, CO 81505.
- Work Location: In-person/onsite
Education
Preferred- High School or better
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
Salary : $19 - $22
