Job Details

ID #17379676
State Wyoming
City Sheridan
Job type Full-time
Salary USD TBD TBD
Source Sheridan Memorial Hospital
Showed 2021-07-27
Date 2021-06-24
Deadline 2021-08-23
Category Healthcare
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Prior Authorization Specialist

Wyoming, Sheridan, 82801 Sheridan USA

Vacancy expired!

ABOUT SHERIDAN MEMORIAL HOSPITAL

Sheridan Memorial Hospital is a progressive, state-of-the-art facility nestled beneath the Big Horn Mountains in beautiful Northeast Wyoming. Founded over 100 years ago, Sheridan Memorial is licensed for 88 beds with over 60 physicians who provide primary medical care and specialty care in more than 15 areas. We are proud of our more than 700 employees who provide personalized, patient-centered care in a healing environment. When people think of excellent healthcare, they think of Sheridan.

JOB SUMMARY:

Service excellence and a culture of kindness are priorities for Sheridan Memorial Hospital and must be maintained while providing personalized attention in a professional manner recognizing individual needs and concerns. The duties required include pre-authorization of services performed within the hospital and clinics per payor guidelines in timely manner.

ESSENTIAL JOB FUNCTIONS:

  • Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.
  • Verifies physician orders are accurate, determines CPT, HCPCS and ICD-10 codes for proper Prior Authorization.
  • Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections.
  • Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.
  • Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.
  • Helps to maintain a professional atmosphere for patients, family members and staff.
  • Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.
  • Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.

POSITION QUALIFICATIONS

Education / Experience / License and Certifications

  • High school graduate or equivalent.
  • Knowledge of CPT, HCPCS, and ICD-10 codes preferred.
  • Medical terminology required.

Additional Skills

  • Ability to read, analyzes, interprets, and communicate effectively in English.

  • Ability to effectively present information and respond to questions from providers, clinical staff, payors, and patients.
  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

  • Ability to interpret a variety of instructions furnished in written, oral, or scheduled form.Proficient with MS Office Suite including Word, Excel and Power Point.

  • Proficient with the EMR system.
  • Ability to solve conflict.

  • Must possess excellent time management and organization skills with attention to detail.
  • Demonstrates critical thinking, creativity, and problem solving.
  • Demonstrates the ability to maintain confidentiality.
  • Ability to write clearly and informatively.

  • Ability to cope with stressful situations and maintain a calm and professional demeanor.
  • Ability to prioritize and perform multiple tasks with many interruptions.

Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights as an applicant under the law, please click here.

Specific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products.

Pre-employment drug and alcohol screening is required.

Vacancy expired!

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