Mille Lacs Health System
Prior Auth Coordinator- Full-Time
Mille Lacs Health System, Onamia, Minnesota, United States, 56359
Prior Auth Coordinator- Full-Time
This position works under the direction of the Health Information Supervisor/Director of Revenue Cycle. The Prior Authorization Coordinator (PAC) is responsible for ensuring that payers are prepared to reimburse Mille Lacs Health System for scheduled services in accordance with the payer-provider contracts. The PAC contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. Additionally, the PAC will work with payers on appeals should they be required. The essential functions of this job are identified with an asterisk (*) at the end of the bullet point. Receive requests for prior authorizations and ensure that they are properly and closely monitored within Mille Lacs Health System standards. Review accuracy and completeness of information requested and ensure that all supporting documents are present. Provide clinical knowledge by assisting with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Collaborate with other departments to assist in obtaining prior authorizations/appeals. Work with Business Office staff to support appeal efforts for both non-authorization and authorization denials. Writes appeals to insurance provider and seeks input from physician on appeals as needed. Manage correspondence with insurance companies and other departments as required. Document all interactions with insurance companies within the electronic medical record. Document all prior authorization information including approval dates, billing units, procedure codes, and prior authorization number in patient's chart. Review insurance denials and submit appeals as necessary. Proactively work on prior authorizations that are due to be expired. Work closely with HI Clerk who performs clerical prior authorization functions. Secure patients' demographics and medical information by using discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations. Completes all required duties, projects and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the Health Information Supervisor/Director of Revenue Cycle. Must complete all required training and attend all mandatory meetings. 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 LPN licensure in the State of Minnesota. CMA certification/registration. Two (2) years of Prior Authorization experience. Two (2) years of experience working in a healthcare setting. Experience working with providers and other clinical staff. Experience with medical terminology and healthcare insurance processes. Preferred Education and Experience RN licensure in the State of Minnesota. Five (5) years of Prior Authorization experience. Five (5) years of experience working in a healthcare setting. Additional Eligibility Qualifications Professional written and verbal communication Expertise with computer-based data Customer/Client Focus Ethical Conduct Flexibility Initiative Personal Effectiveness/Credibility Stress Management/Composure Teamwork Orientation Technical Capacity Thoroughness Time Management Quality and Safety focused
This position works under the direction of the Health Information Supervisor/Director of Revenue Cycle. The Prior Authorization Coordinator (PAC) is responsible for ensuring that payers are prepared to reimburse Mille Lacs Health System for scheduled services in accordance with the payer-provider contracts. The PAC contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. Additionally, the PAC will work with payers on appeals should they be required. The essential functions of this job are identified with an asterisk (*) at the end of the bullet point. Receive requests for prior authorizations and ensure that they are properly and closely monitored within Mille Lacs Health System standards. Review accuracy and completeness of information requested and ensure that all supporting documents are present. Provide clinical knowledge by assisting with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Collaborate with other departments to assist in obtaining prior authorizations/appeals. Work with Business Office staff to support appeal efforts for both non-authorization and authorization denials. Writes appeals to insurance provider and seeks input from physician on appeals as needed. Manage correspondence with insurance companies and other departments as required. Document all interactions with insurance companies within the electronic medical record. Document all prior authorization information including approval dates, billing units, procedure codes, and prior authorization number in patient's chart. Review insurance denials and submit appeals as necessary. Proactively work on prior authorizations that are due to be expired. Work closely with HI Clerk who performs clerical prior authorization functions. Secure patients' demographics and medical information by using discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations. Completes all required duties, projects and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the Health Information Supervisor/Director of Revenue Cycle. Must complete all required training and attend all mandatory meetings. 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 LPN licensure in the State of Minnesota. CMA certification/registration. Two (2) years of Prior Authorization experience. Two (2) years of experience working in a healthcare setting. Experience working with providers and other clinical staff. Experience with medical terminology and healthcare insurance processes. Preferred Education and Experience RN licensure in the State of Minnesota. Five (5) years of Prior Authorization experience. Five (5) years of experience working in a healthcare setting. Additional Eligibility Qualifications Professional written and verbal communication Expertise with computer-based data Customer/Client Focus Ethical Conduct Flexibility Initiative Personal Effectiveness/Credibility Stress Management/Composure Teamwork Orientation Technical Capacity Thoroughness Time Management Quality and Safety focused