Note: The job is a remote job and is open to candidates in USA. Hopedale Medical Complex is seeking a Prior Authorization Specialist to ensure reimbursement for scheduled services in line with payer-provider contracts. The specialist will contact payers for service authorizations, determine insurance coverage for tests/procedures, and provide financial counseling to patients.
Responsibilities
- Verifies patient’s insurance and benefits information
- Obtains prior authorizations from third-party payers in accordance with payer requirements
- Works with other departments to gather the clinical information required by the payer to authorize services
- Maintains accurate records of authorizations within the EMR
- Works with the business office to support appeal efforts for authorization related denials
- Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality
- Maintains professional tone at all times when communicating with patients and payer representatives
- Completes approved adjustments as requested and adds charges as requested
- Keep filing updated for easy access
- Keep the waiting area orderly throughout the day
- Assist in maintaining accurate patient business records
- Orders and maintains supplies as required
- Maintains good working relationship both within the department and with other departments
- Demonstrates an ability to be flexible, organized and function well in a stressful situation
- Treat patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information
- Follows established departmental policies, procedures, and objectives. Continues quality improvement objectives and safety, environmental and/or infection control standards
- Other duties as assigned by the Patient Access Manager
Skills
- Ensures that payers are prepared to reimburse Hopedale Medical Complex for scheduled services in accordance with the payer-provider contract
- Contacts payers to request service authorizations
- Collects financial and/or demographic information from patients as needed
- Determines insurance coverage for tests/procedures and counsels patients regarding this coverage
- Performs financial counseling duties
- Verifies patient's insurance and benefits information
- Obtains prior authorizations from third-party payers in accordance with payer requirements
- Works with other departments to gather the clinical information required by the payer to authorize services
- Maintains accurate records of authorizations within the EMR
- Works with the business office to support appeal efforts for authorization related denials
- Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality
- Maintains professional tone at all times when communicating with patients and payer representatives
- Completes approved adjustments as requested and adds charges as requested
- Keeps filing updated for easy access
- Keeps the waiting area orderly throughout the day
- Assists in maintaining accurate patient business records
- Orders and maintains supplies as required
- Maintains good working relationship both within the department and with other departments
- Demonstrates an ability to be flexible, organized and function well in a stressful situation
- Treats patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information
- Follows established departmental policies, procedures, and objectives
- Continues quality improvement objectives and safety, environmental and/or infection control standards
- Other duties as assigned by the Patient Access Manager
Benefits
- Tuition Reimbursement
- Excellent benefits - health, dental, vision, and life and disability insurance
- Quality childcare located on site
- HMC Wellness Center membership
- 401(k) plan with employer match
- Employee Daycare Rates
Company Overview
Hopedale Medical Complex is a non-profit organization that offers independent living facilities and professional health & medical services. It was founded in 1955, and is headquartered in Hopedale, Illinois, USA, with a workforce of 201-500 employees. Its website is https://www.hopedalemc.com/.Company H1B Sponsorship
Hopedale Medical Complex has a track record of offering H1B sponsorships, with 3 in 2022. Please note that this does not guarantee sponsorship for this specific role.
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