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Prior Authorization Specialist - Clinics

UnityPoint Health Finley Hospital

1 Positions

ID: 25887536

Posted On 01/19/2023

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

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

High School graduate or GED equivalent

Experience:

· 1-3 years of experience in/with surgery scheduling preferred. Fluency in Medical Terminology desirable. Experience with critical decision making

License(s)/Certification(s):

Knowledge/Skills/Abilities:

Required English Skills

· Basic reading skills

· Basic writing skills

· Basic oral skills

Communication Skills

· Ability to respond appropriately to customer/co-worker

· Interaction with a wide variety of people

· Maintain confidential information

· Ability to communicate only the facts to recipients or to decline to reveal information

· Ability to project a professional, friendly, helpful demeanor

Computer Skills

· Basic computer knowledge: Uses word processing, spreadsheet, e-mail application, and web browser. Comfortable with Windows OS and learning new applications.

Other:

Use of usual and customary equipment used to perform essential functions of the position.

  • Area of Interest: Billing and Coding;
  • FTE/Hours per pay period: 1.0;
  • Department: Spec Care- Cardiology;
  • Shift: Days, Monday - Friday, 7:30 am - 4:00 pm or 8:00 am - 4:30 pm, for 80 hours per pay period. There is no nights or weekends.;
  • Job ID: 127087;

Primary Contact

13511

Michelle Pickel

HR Recruiter, HR

563-589-2608

Phone

Phone

Phone

Fax

michelle.pickel@unitypoint.org

Email

True

False

False

Job Details

Categories

Health Care

Location

Dubuque, IA

Job Type

Employee

Full/Part

Full Time

Company ID

168

Job REQ #

25887536

# Positions

1

Start Date

20230119

End Date

20230209

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UnityPoint Health Finley Hospital

About the Company

A CAREER AT UNITYPOINT HEALTH - FINLEY HOSPITAL

UnityPoint Health team members come for a job, but stay for a career. As a team member, regardless of your position, you'll get the chance to change lives on a daily basis in order to deliver our vision of the Best Outcome for Every Patient, Every Time. That privilege drives employees' passion for making a difference in the lives of our patients, helping them create healthier, more rewarding lives.

At UnityPoint Health - Finley Hospital, we know our collective actions determine the experience we create. Our team members strive to work as one through four key values:

* Foster Unity
* Own the Moment
* Champion Excellence
* Seize Opportunity

If you are interested in joining our team, please visit http://www.unitypoint.org/dubuque/employment-opportunities to learn about our many opportunities and to fill out an online application.

ABOUT OUR HOSPITAL

UnityPoint Health Finley Hospital is a 126-bed community hospital. We employ more than 800 full-and-part-time employees.  Finley Hospital is a not-for-profit, locally owned, regional healthcare facility part of the UnityPoint Health system. Finley Hospital is committed to bringing the best medical care to the tri-state area. We offer comprehensive, full service health care that is coordinated around our patients.  We have consistently been recognized as a leader in health care.