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Prior Authorization Specialist - Clinics

Job Overview

Overview

We are looking for a full-time Prior Authorization Specialist to join our Clinics. Work hours will be days, Monday - Friday, 7:30 am - 4:00 pm pr 8:00 am - 4:30 pm, for 80 hours per pay period, and as needed.

Under the direct supervision of the manager, performs assigned duties, including telephonic support for on-line authorization of routine services, contacting specialty are providers, monitoring patient eligibility, and performing on-line data entry of routine authorizations/denials.

Why UnityPoint Health? 

• Commitment to our Team – We’ve been named a  Top 150 Place to Work in Healthcare 2022  by Becker’s Healthcare for our commitment to our team members. 
• Culture – At UnityPoint Health, you Come for a fulfilling career and experience  a culture  guided by uncompromising values and unwavering belief in doing what's right for the people we serve. 
• Benefits – Our competitive  Total Rewards  program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. 
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation. 
• Development – We believe equipping you with support and  development opportunities  is an essential part of delivering a remarkable employment experience. 
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve. 

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.  https://dayinthelife.unitypoint.org/  

Responsibilities

Serves as department expert for prior authorizations

• Establishes effective rapport and work closely with QA, HCC, Administration, Clinical, Patients, Families, and Billing Teams to ensure that all patients have authorization for services performed.
• Contacts providers with authorization, denial and appeals process as applicable.
• Verifies eligibility and authorization needs of current patients for continued services.
• Works from spreadsheets in determining authorization needs.
• Performs telephonic and on-line authorization requests for our services.

Identifies, processes, and communicates the completion of all department patient accounts/orders that require insurance verification, prior authorization, and/or pre-certification in a timely manner

• Assists in gathering information needed for clinical staff to determine continued services.
• Assists in educating and acts as a resource to clinical and non-clinical departments.
• Assists with the identification and reporting of potential quality management issues.
• Accurately enter required information into all applicable systems.
• Uses Diagnosis Coding, HCPCS, Revenue and CPT coding.
• Meets specified deadlines as required for continued patient satisfaction.

Serves as the department billing liaison for patients and UPH CBO

• Demonstrates a professional image in dealing with the public, patients, families and payors.
• Maintains regular and consistent attendance at work.
• Behaves in a manner consistent with Mission, Vision, Values and Expectations for Excellence.
• Maintains compliance with OSHA, Accreditation Standards and Risk Management guidelines.
• Maintains compliance with Personnel policies and procedures.
• Behaves in a manner consistent with all Corporate Compliance policies and procedures.
• Meets measures as determined and required for job productivity and performance improvement.
• Responsible for completion of communication tasks and activities in a timely manner. This would include, but is not limited to: responding to email, voicemail or telephone messages, promptly, accurately, and professionally; attending staff meetings as scheduled or viewing videotapes of those meetings; asking questions of team members and supervisors when needing clarification about various day-to-day issues or patient needs; and reviewing employee communication pieces.
• Performs other duties as requested by the Manager

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
• Demonstrates ability to meet business needs of department with regular, reliable attendance.
• Employee maintains current licenses and/or certifications required for the position.
• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
• Completes all annual education and competency requirements within the calendar year.
• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Qualifications