Full-Time - Prior Authorization Specialist

Wilson Health is looking for a Full-time- Prior Authorization Specialist for our Patient Access Department location in Sidney, Ohio (North Dayton, Ohio) area. Key Perks and Benefits:

• Access to Employer Direct Care Clinic. Free medical care and pharmacy services for all benefit eligible employees. Dependents are eligible for free medical care if they are covered by Wilson Health's medical insurance plan.
• Generous paid time off program beginning day one of employment.
• Medical Insurance: Your Choice of Two High Deductible Health Plan Options or a PPO, Dental and Vision Insurance.
• H S A with employer contribution for eligible health plans, FSA for medical and dependent care expenses
• Company Paid Life Insurance Short-Term and Long-Term Disability Insurance.
• Voluntary Accident, Critical Illness, and employee and dependent Life and AD&D Insurance.
• Industry leading retirement plan- employer contributions begin day one, no waiting period for participation.
• Tuition Assistance Program.

Who We Are: At Wilson Health, our mission is to improve the health and wellness of our communities by delivering compassionate, quality care. We are committed to making a difference for our neighbors, friends, and family and our vision is to be a trusted, nationally-recognized leader of innovative, collaborative community health. Employment Status: Full-time 40 work week Working Hours: Monday – Friday (7:00AM - 5:00PM) Shift: 1 st Shift Position Reports to: Director of Patient Access SUMMARY: This position is responsible for the verification and documentation of insurance benefits and timely submission of initial prior authorization requests for outpatient and surgical procedures. Responsible for review and preparation of chart documents to accompany complex authorization requests. The Prior Authorization Specialist will provide appropriate information to third party payers and communicate with department clinicians when additional information is required to assure prior authorization is completed appropriately. ESSENTIAL DUTIES AND RESPONSIBILITIES:

• include the following, but other duties may be assigned.
• Screens outpatient orders prior to admission for insurance eligibility, coordination of benefits, coverage of requested services and prior authorization requirements.
• Contacts payer or third party to obtain prior authorization for ordered services, including but not limited to Radiology, Cardiology, Surgery, Ortho, Women’s Center, medicals, and various other outpatient services. The can be completed via phone, fax and or payer portals.
• Documents prior authorization appropriately in EMR and maintains communication with departments whose services need payer approval. Scans in all records from payers with communication of approval / denials.
• Collaborates with patient if insurance cannot be verified and refers self-pay patients to financial assistance resources.
• Reviews schedules to ensure prior authorization is obtained and documented prior to admission and communicate with scheduling team when rescheduling is necessary.
• Identifies payer challenges and escalates to Patient Access Supervisor and/or Patient Access Director.
• Effectively present information and respond to questions from managers, staff members, patient, patient’s family, and the general public. These would include the pediatric client, the adolescent client, the young-middle aged client, and the geriatric client.
• Demonstrates a comprehensive knowledge in changing government regulations. Must maintain local and national medical review policies and precertification of outpatients. Will screen diagnosis on patients with Medicare Health Insurance for procedures that have LMRP’s in place and request additional information from Dr Offices as needed or present patient with an Advanced Beneficiary Notice if needed for non-compliant diagnosis.
• Additional responsibilities may be required for lead roles such as providing recommendations for process improvement and maintaining quality aspects within Patient Access.
• Aware of the functions within the scope of the hospital policy/procedure. Aware of and responds to Disaster/Fire Plan per policy. Maintains patient confidentiality at all times.
• Performs other duties within scope of responsibility as assigned.

EDUCATION AND/OR EXPERIENCE: High School diploma or general education degree (GED); one to three years related experience and/or training; or equivalent combination of education and experience. OTHER SKILLS AND ABILITIES: Must have excellent typing skills and basic knowledge of personal computers. Ability to read and interpret documents such as 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. Insurance experience, previous authorizations and scheduling experience. Mission & Vision & Values:

• Improve the health and wellness of the community by delivering compassionate, quality care.
• Be a trusted, nationally-recognized leader of innovative, collaborative, community health.
• A.S.P.I.R.E - Always serve with professionalism, integrity, respect, and excellence.

EOE (Equal Opportunity Employer)