Mille Lacs Health System
Prior Authorization Specialist (Full-Time Days)
Mille Lacs Health System, Onamia, Minnesota, United States, 56359
Summary
The Prior Authorization Specialist works under the direction of the Health Information Manager. This role ensures that payers are prepared to reimburse Mille Lacs Health System for scheduled services in accordance with payer-provider contracts. Responsibilities include requesting service authorizations, preparing, and submitting documentation, and managing appeals. The position requires strong communication, insurance knowledge, and the ability to work independently and collaboratively in a fast-paced healthcare environment.
Job Duties The essential functions of this job are identified with an asterisk (*) at the end of the bullet point.
Receive and monitor prior authorization requests in accordance with MLHS standards. *
Review accuracy and completeness of documentation and ensure all supporting materials are present. *
Assist with medical necessity documentation to expedite approvals. *
Collaborate with departments and providers to obtain authorizations and support appeals. *
Write and submit appeals to insurance providers, including physician input when needed. *
Manage correspondence with insurance companies and document all interactions in the EMR. *
Record prior authorization details including approval dates, billing units, procedure codes, and authorization numbers. *
Review insurance denials and proactively submit appeals. *
Track and renew expiring authorizations. *
Work closely with other staff performing prior authorization functions. *
Secure patient demographics and medical information in compliance with HIPAA regulations. *
Complete all required duties, projects, and reports in a timely manner. *
Attend mandatory meetings and complete required training. *
Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Employee will comply with all Mille Lacs Health System (MLHS) policies, including safety policies, procedures, and rules. All will be expected to report unsafe conditions to a member of management.
Required Education and Experience
Medical Assistant (MA) certification or Licensed Practical Nurse (LPN) licensure in the State of Minnesota
Minimum 1-2 years of prior authorization experience in a healthcare setting
Experience with medical terminology and insurance processes
Strong verbal and written communication skills
Proficient computer and business skills
Ability to manage multiple priorities and work independently or in a team
Knowledge of insurance eligibility and HIPAA compliance
Preferred Education and Experience
5 years of prior authorization experience
5 years of experience in a healthcare setting
Additional Eligibility Qualifications
Detail-oriented and self-directed
Ethical conduct and professionalism
Initiative and flexibility
Time management and stress management
Teamwork orientation and technical capacity
Quality and safety focused
Position Type/Expected Hours of Work
Full-time: 40 hours/week
Monday-Friday, 8:00 AM - 4:30 PM (training hours may vary)
No evenings or weekends
Supervisory Responsibility None
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Job Duties The essential functions of this job are identified with an asterisk (*) at the end of the bullet point.
Receive and monitor prior authorization requests in accordance with MLHS standards. *
Review accuracy and completeness of documentation and ensure all supporting materials are present. *
Assist with medical necessity documentation to expedite approvals. *
Collaborate with departments and providers to obtain authorizations and support appeals. *
Write and submit appeals to insurance providers, including physician input when needed. *
Manage correspondence with insurance companies and document all interactions in the EMR. *
Record prior authorization details including approval dates, billing units, procedure codes, and authorization numbers. *
Review insurance denials and proactively submit appeals. *
Track and renew expiring authorizations. *
Work closely with other staff performing prior authorization functions. *
Secure patient demographics and medical information in compliance with HIPAA regulations. *
Complete all required duties, projects, and reports in a timely manner. *
Attend mandatory meetings and complete required training. *
Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Employee will comply with all Mille Lacs Health System (MLHS) policies, including safety policies, procedures, and rules. All will be expected to report unsafe conditions to a member of management.
Required Education and Experience
Medical Assistant (MA) certification or Licensed Practical Nurse (LPN) licensure in the State of Minnesota
Minimum 1-2 years of prior authorization experience in a healthcare setting
Experience with medical terminology and insurance processes
Strong verbal and written communication skills
Proficient computer and business skills
Ability to manage multiple priorities and work independently or in a team
Knowledge of insurance eligibility and HIPAA compliance
Preferred Education and Experience
5 years of prior authorization experience
5 years of experience in a healthcare setting
Additional Eligibility Qualifications
Detail-oriented and self-directed
Ethical conduct and professionalism
Initiative and flexibility
Time management and stress management
Teamwork orientation and technical capacity
Quality and safety focused
Position Type/Expected Hours of Work
Full-time: 40 hours/week
Monday-Friday, 8:00 AM - 4:30 PM (training hours may vary)
No evenings or weekends
Supervisory Responsibility None
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