Centers for Gastroenterology Hiring for Prior Authorization Specialist at Fort Collins, CO Full Time

Position Title: Procedure Prior-Authorization Specialist

s to: Front Office Manager

Salary range: Min: $18.67 Mid: $20.75 Max: $22.82

Summary: The Prior Authorization Representative will be responsible for obtaining insurance eligibility and prior authorization for procedure appointments scheduled at all facilities as well as verifying eligibility for office visit appointments. This position may perform collection duties in the check-out position as well. All other duties as assigned and regular attendance is required.

Essential Job Functions

• Obtain prior authorization and verify insurance eligibility for scheduled outpatient procedures.
• Ensure the correct diagnosis codes and CPT codes are being used.
• Confirm if patients’ insurance is in/out of network and process accordingly.
• Communicate with patient(s) if there are difficulties obtaining prior authorization or determining eligibility.
• Communicate with the outpatient facilities if there are difficulties obtaining prior authorization.
• Document information in appropriate fields within EPIC (EMR) such as guarantor account, referral notes, and appointment notes.
• Review clinical documentation to locate pertinent information to obtain authorization.
• Educate patients about commercial insurance plan coverage and Medicare A & B/Medicare Replacement plans.
• Work with the Veterans Administration (VA) and Tricare to obtain authorization and/or insurance referrals.
• Send out financial packets for patients, if applicable.
• Perform other duties assigned.

Competencies:

• Effective Communication—Ability to communicate clearly both verbally and in writing with diverse groups; understanding of and ability to explain insurance and financial information to patients, including discussing sensitive information.
• Documentation and Information Recording—Possess excellent attention to detail as well as data entry skills. Accurate entry of patient information; and ability to investigate, ask follow-up questions, or track timelines to resolve issues that arise. Maintain confidential information.
• Customer Service—Listen attentively; respond to questions appropriately and timely. Possess kind and pleasant demeanor as well as demonstrate patience over the phone. Ability to take direction as needed.
• Time Management—Must be able to work under pressure and complete multiple projects or tasks according to established timeframes. Enjoy working in a high-energy, fast-paced environment. Demonstrate resourcefulness and creative problem-solving as needed.
• Professionalism—Build solid working relationships and be support of co-workers; foster a friendly work environment, focused on providing patient access.

Preferred Competencies:

• Knowledge of ICD-10 and CPT codes needed for authorization and coverage purposes.
• Knowledge of medical insurance terminology (i.e. Deductible, Co-Insurance, Out-of-pocket max. etc.)
• Basic knowledge of computer functions, including Microsoft Office programs.

Performance Measurement

• 95 % accuracy rate for obtaining prior authorization.
• Authorize appointments scheduled at least 4 weeks out.
• Patient calls are returned within 48 hours of receiving call.
• Employee is generally regarded as polite and helpful by patients and co-workers.

Education and Experience

High School Graduate or equivalent

Minimum of 1-year related experience in a medical office.

Working Conditions and Physical Requirements

• Ability to walk, stand, stoop, bend, or sit for extended periods of time.
• Physical demands: percentage of time spend in each activity (estimate).
• Walking 20% – assisting patients, delivering information to other departments, collaborating with other department employees.
• Sitting 80% – checking in patients, answering the telephone, working in the call center, working on the computer.
• Number of pounds that may be lifted, carried, pushed or pulled: up to 30lbs.
• Climbing on step ladders to reach top shelves, stooping, kneeling, crouching, reaching, fingering (like keyboarding, controls on a scanner, fax, etc.)
• Ability to speak clearly to be understood by our patients and employees.
• Ability to hear within a normal range. Able to hear patients on the phone in a noisy environment.
• Acuity near and far. Ability to see within normal parameters, and to distinguish colors.
• Works in a well-lit heated/air conditioned environment. Temperatures between 68 and 74 degrees.
• Work may involve exposure to communicable diseases, medical preparations and other conditions common to a clinic environment.

Equipment Used

Computer, printer, multi-line telephone, headset, fax machine, scanner, postage machine.

Equal Employment Opportunity

The Centers for Gastroenterology is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, military or veteran status.

Job Type: Full-time

Pay: $18.67 – $22.82 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Professional development assistance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Ability to commute/relocate:

• Fort Collins, CO 80525: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Insurance verification: 1 year (Preferred)
• Medical billing: 1 year (Preferred)
• Medical office: 1 year (Required)

Work Location: Hybrid remote in Fort Collins, CO 80525