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 payers are prepared to reimburse for scheduled services. The role involves contacting payers for service authorizations, determining insurance coverage, and providing 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
- 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
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
- Infants (6 weeks to 15 months) - $133 weekly, $27 daily
- Toddlers (15 months to 2 yrs) - $126 weekly, $26 daily
- 2 years to 3 years - $119 weekly, $25 daily
- 4 years to 5 years - $112 weekly, $23 daily
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