What are the responsibilities and job description for the Prior Authorization Specialist - Family Practice Clinics position at Upland Hills Health?
Position Title: Prior Authorization Specialist
Location: Upland Hills Health - Mineral Point Clinic
Role & Department: Prior Authorization Specialist in the Family Practice Clinics
Hours & Shift: Full-time (1.0 FTE) day shift position, Monday through Friday 8 a.m. to 5:00 p.m.
Role Responsibilities:
- This position is responsible for obtaining precertification, authorizations and insurance benefits for scheduled services to ensure insurance payments
- Obtains patient’s insurance benefit information with the insurance company
- Notifies insurance company in a timely manner of scheduled patients in preparation of hospital outpatient services
- Obtains missing medical and insurance information from a variety of sources to enable authorizations to be completed
- Documents case status, actions and outcome in the authorization database
- Clearly documents authorization information in Epic
- Communicates with clinical staff as needed
- Communicates any updates to patient demographics or insurance coverage to the Business Office
- Assists in training and development of new personnel
- Can easily manage multiple authorization requests at once
- Performs other duties as assigned
Qualifications:
- Two year or greater educational degree preferred
- Minimum of two years healthcare or insurance experience is required
- Knowledge of medical terminology is required
- Excellent communication and organizational skills are required
- Attention to detail and accuracy are required
- Ability to handle multiple priorities and prioritize as needed
- Previous experience with interpreting physician orders and notes is preferred
- Previous experience with CPT codes and ICD-10 diagnosis codes is preferred
- Previous experience with Epic is preferred
- Previous experience with the Microsoft Office Applications programs is beneficial
Employee Benefits:
- Comprehensive benefits packages available for both part and full-time employees!
- Paid Time Off (PTO) benefits begin to accrue on day one!
- Retirement Plan with matching dollars available!
- Two wellness center facilities that employees are eligible to use free of charge & a minimal fee for spouses!
- Many Employer Sponsored Events held throughout the year to celebrate our employees!
Why Upland Hills Health: Upland Hills Health (UHH) consistently ranks as a very high performing health care institution in Southwestern Wisconsin. Located just 40 minutes from Madison, WI and as well from Dubuque, IA, the area is surrounded by wonderful communities and beautiful scenery. For over 100 years, Upland Hills Health has been dedicated to the promise of offering the highest standard of healthcare. Our community-minded staff emphasizes providing quality, comprehensive healthcare while offering a comfortable, neighborly welcome to everyone who walks through our doors. Here, neighbors care for neighbors!
Posting date: February 27, 2025
