Prior Authorization Specialist
: Job Details :

Overview:

RiverView Health, is a community owned, membership based non-profit organization that was formed in 1898 and continues to be the sole community hospital in Crookston, MN.

RiverView Health operates a 25 bed Critical Access Hospital, RiverView Recovery Center; a chemical dependency outpatient treatment program, RiverView Home Care and five primary care and specialty clinics in the hospitals service area.

We have a robust scholarship program for those furthering their education in a medical field, excellent benefits, and a friendly work environment. Full-time benefits include health insurance, free single vision and basic dental insurance, life insurance, long-term disability and short-term disability, and employer HSA contributions. Other benefits include employer pension matching, shift differential, incentive/premium pay, free annual biometric screening and paid volunteer time off.

RiverView is an Equal Employment Opportunity employer.

Responsibilities:

RiverView Health has a full-time (64 hours every 2 weeks) opening for a Prior Authorization Specialist. The prior authorization specialist is responsible for ensuring that payers are prepared to reimburse RiverView Health for scheduled services in accordance with the payer-provider contract. They also gather additional medical records from other providers to support medical necessity requirements and alert the clinicians involved if there are issues with referrals or complications with insurance coverage. For patients who do not receive insurance coverage, the prior authorization specialist refers accounts to the financial counselor and/or identifies the patients who need to receive a Medicare Advance beneficiary Notice of Noncoverage (ABN). In addition, they work collaboratively with many different individuals to help support appeal efforts for authorization-related denials while also staying in close contact with the patient as needed. Salary range is $19.55 - $27.38 and starting wage is dependent on experience.

Qualifications:

• High school diploma or equivalent (GED) required.
• Associates degree in healthcare or business administration and/or related/comparable experience preferred.
• 1 year related working experience in healthcare is required.
• Work experience with the Prior Authorization process and experience with EPIC EMR system is preferred.
• Working knowledge of computers, excellent communication and organization skills is preferred.