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PRIOR AUTHORIZATION SPECIALIST

MOUNTAIN VIEW HOSPITAL LLC
Idaho Falls, ID Other
POSTED ON 12/22/2024
AVAILABLE BEFORE 2/22/2025

Job Details

Job Location:    Idaho Heart Institute - Idaho Falls, ID
Position Type:    Full Time
Education Level:    High School
Salary Range:    Undisclosed
Travel Percentage:    None
Job Shift:    Any
Job Category:    Health Care

Description

Mountain View Hospital is looking for a Prior Authorization Specialist to join our Team!

 

JOB SUMMARY: The Prior Authorization Specialist will obtain prior authorizations for diagnostic imaging, cardiac imaging, Veterans Administration authorizations, and referral authorizations for some specialist appointments. This position will secure the prior authorization and notify the rendering party in a timely manner, so our patients receive the services needed without delay.

 

BENEFITS: Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

  • Medical, Dental and Vision Insurance
  • Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
  • Retirement Plans (401K with up to 6% match)
  • Earned Quarterly Bonus Program
  • Education Reimbursement Program
  • Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

DUTIES AND RESPONSIBILITIES:

1. Receive request for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.
2. Verify necessary information and records in the medical record. Ensure the patient’s medical record and any diagnostic tests are received and scanned into the electronic medical record prior to the scheduled procedure.
3. Accurately enter all referral data into the system and update established patient files, as necessary.
4. Process GAP Referrals
5. Verify patient insurance, in the case that the insurance information is not in the EMR system, the prior authorization specialist will obtain the information from the patient.
6. Obtain Prior Authorization/VA Referral per payor protocols.
7. Process VA referrals and submit medical records to insurance carriers to expedite prior authorization processes.
8. Manage correspondence with insurance companies, VA, physicians, specialist, and patients as needed for prior authorization, including documenting in the EHR as appropriate.
9. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
10. Review accuracy and completeness of information requested and ensure that all supporting documents are present.
11. Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
12. Prioritize the incoming authorizations by level of urgency to the patient.
13. Secure patient information in accordance with MVH policy/procedures.
14. Reviews samples of prior authorizations of team members to ensure accuracy.
15. Distributes authorization changes to team timely.
16. Ability to work well with others; be a positive example and motivating personality within the clinic.
17. Conduct regular meetings with all staff. Serves on hospital wide committees as assigned.
18. Oversee clinic training/education when necessary.
19. Attends/participates in all available educational opportunities to stay in compliance with insurance and government regulations.
20. Always maintains patient confidentiality.
21. Responsible for knowing policies and being familiar with services offered.
22. Performs other job-related duties as assigned by management.
23. The employee is required to comply with all IHI and MV/IFCH standards and other company policies and procedures for payment card acceptance and security.
24. Other duties as assigned.

 

About Mountain View:

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

Qualifications


Education/Certification: High school diploma or general education degree (GED).

Experience: Minimum of two years healthcare experience in medical billing, medical prior authorizations, or health insurance. Working knowledge of ICD-10, CPT coding. Experience handling VA authorizations.

Language/Communication: Ability to read and interpret documents such as patient statements, safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Equipment/Technology: Ability to use an EMR system and operate basic computer functions and software.

Mental Capabilities: : Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Interpersonal: Ability to work well with others

 

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