- Minimum of two (2) years' experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required.
- Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required.
- Possess a working knowledge and understanding of ICD-9 and CPT codes required.
- Possess i nsight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required.
- Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed. Meditech experience preferred.
- Excellent verbal and written communication skills including the ability to communicate effectively with various audiences .
- Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
- Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
- Responsible for obtaining accurate prior authorizations for facility and professional charges related to scheduled patient appointments per department procedure and protocol.
- Performs timely and accurate submission of CPT, HCPCS codes and medical records to insurance carriers to expedite prior authorization requests.
- Accurately secures patients' demographics and medical information and ensures all procedures are in line with HIPPA compliance and regulations.
- Reviews accuracy and completeness of information requested and ensures all supporting documents are present. Collaborates with stakeholders as appropriate.
- Prioritizes incoming authorization requests according to department procedure and protocol. Confirms accuracy of CPT and ICD 10 diagnoses in the procedure order.
- Maintains the Logan Health intranet related to payer requirements needed to successfully obtain a prior authorization.
- Contacts patient and/or clinic to advise if authorization request has not been obtained prior to date of service.
- Researches and works with appropriate stakeholders in initiating retro authorization requests and resolving authorization denials as needed. Prepares, submits, and tracks appeals as necessary. Accurately documents patient accounts of all actions taken.
- Informs, educates, and communicates with leadership to include, but may not be limited to; billing or authorization concerns, backlogs, insurance issues, problematic accounts, documentation issues, etc.
- Adapts to changing circumstances to meet the needs of patient flow.
- Exhibits written and verbal professionalism at all times when interacting with others. Ensures all departmental transactions and interactions are completed with integrity, confidentiality, and professionalism.
- The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.
- Criminal background check
- Reference checks
- Drug Screening
- Health and Immunizations Screening
- Physical Demand Review/Screening
-
Logan Health Whitefish, United StatesLogan Health · Scheduling and Prior Authorization Specialist · Whitefish , · Montana · Apply Now · This position is responsible for obtaining prior authorizations for all procedural orders by successfully completing the prior authorization process per department procedure an ...
-
BlueWave Solutions Lakeside, United StatesAre you looking for a new professional development opportunity? Then we have an exciting challenge for you. · On behalf of our client, a maximum care hospital in the Duisburg area with approximately beds, we are currently looking for a resident physician (m/f/d) with advanced tr ...
-
Apex Ventures Lakeside, United StatesFor an academic teaching hospital, we are currently seeking a dedicated · Resident Physician in Hematology and Oncology (m/f/d) · in the greater Munich area. · The offer: · Wide range of tasks and services in the field of hematology and oncology with the opportunity for comprehen ...
-
Permitting Specialist
1 week ago
Ledcor Group Columbia Falls, United StatesJob Summary:The Permitting Specialist is responsible for researching, preparing documentation, and acquiring appropriate municipal and agency permits for the proposed installation of cable and fiber optics networks. This individual prepares permit application packages required by ...
-
Permitting Specialist
3 weeks ago
Ledcor Group Columbia Falls, United StatesJob Summary:The Permitting Specialist is responsible for researching, preparing documentation, and acquiring appropriate municipal and agency permits for the proposed installation of cable and fiber optics networks. This individual prepares permit application packages required by ...
-
Permitting Specialist
2 weeks ago
Ledcor Group Columbia Falls, United StatesDescription · Job Summary: · The Permitting Specialist is responsible for researching, preparing documentation, and acquiring appropriate municipal and agency permits for the proposed installation of cable and fiber optics networks. This individual prepares permit application p ...
-
Permitting Specialist
2 weeks ago
Ledcor Group Columbia Falls, United StatesJob Summary: · The Permitting Specialist is responsible for researching, preparing documentation, and acquiring appropriate municipal and agency permits for the proposed installation of cable and fiber optics networks. This individual prepares permit application packages required ...
-
Scheduling Specialist
3 weeks ago
Logan H ealth Kalispell, United StatesScheduling Specialist - Patient Scheduling page is loaded · Scheduling Specialist - Patient Scheduling · Apply · remote type · On-Site · locations · Kalispell, Montana · time type · Full time · posted on · Posted 2 Days Ago · job requisition id · Req6753 · Job Descri ...
-
Program Specialist 1
1 week ago
State of Montana Kalispell, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., · Denver, CO · or · City and state must be separated by a comma followed by a space (e.g., · Houston, TX ) · State of Montana · Program Specialist 1 - Fire Adapted Communities Specialis ...
-
Program Specialist 1
1 week ago
State of Montana Kalispell, United States: · Montana Department of Natural Resources and Conservation's mission is to help ensure that Montana's land and water resources provide benefits for present and future generations. · The DNRC believes employees are their most important asset. The DNRC empowers employees to exer ...
-
Forester 2
3 weeks ago
State of Montana Kalispell, United StatesJob Overview: · The position performs advanced professional forest management activities in close coordination with the US Forest Service under the general supervision of the Area Good Neighbor Authority Program Specialist. The incumbent provides contract package development and ...
-
RN - Behavioral Health
3 weeks ago
Logan Health Kalispell, United StatesJob Description Summary: · Work and live in beautiful Northwest Montana We have opportunties for Behavioral Health Registered Nurses to join our team in Kalispell, Montana. · We are located in the Flathead Valley, just a short drive to Glaciar National Park, Whitefish Mountain Sk ...
-
RN - Pediatrics Hematology/Oncology - Day Shift
2 weeks ago
Logan Health Kalispell, United StatesJob Description Summary: · Logan Health Children's, located in picturesque Kalispell, Montana, has an opportunity for a full-time Registered Nurse to join their Pediatrics team. The ideal candidate would have experience with hematology/oncology patients. · Logan Health Children's ...
-
Retail Store Customer Service Specialist
3 weeks ago
Sherwin-Williams Somers, United States· This is position is essential to the success of our retail stores. Customer Service Specialists work closely with wholesale and retail customers to determine their needs, answer their questions about Sherwin-Williams products, and recommend the right solutions. Customer Servic ...
-
Treasury Client Relationship Specialist I
3 days ago
Glacier Bank Kalispell, United StatesAbout the Role: · Come join a company that celebrates its employees and deeply cares about the community of Kalispell. Voted Best Employer and Best Place to Work in the Flathead · The Treasury Client Relationship Specialist is the coordinator for all treasury products. · Empl ...
-
Patient Access Representative
1 week ago
Greater Valley Health Center Kalispell, United StatesJob Description · Job DescriptionSalary: $17-$19 · Are you looking at a career in healthcare and want to get your foot in the door? Here is your opportunity At Greater Valley Health Center, you will work with a great team in a supportive environment that requires excellent commun ...
-
InsideHigherEd Lakeside, United StatesBuena Vista University is seeking a talented and experienced Subject Matter Expert (SME) to join our team on a remote contract basis. The SME will be responsible for creating three comprehensive online courses focused on healthcare leadership. This individual should have a deep u ...
-
Sales Development Representative
1 week ago
Coca-Cola Bottling Company High Country Kalispell, United StatesJob Type Full-time Description Coca-Cola, with its many brands, has been recognized and enjoyed by people around the world for over a century. Founded in 1956, Coca-Cola Bottling Company High Country is a family owned, regional Bottler serving portions of Colorado, Minnesota, Mo ...
-
RN - Behavioral Health
3 weeks ago
Logan Health Kalispell, United States Full timeJob Description Summary: · Work and live in beautiful Northwest Montana We have opportunties for Behavioral Health Registered Nurses to join our team in Kalispell, Montana. · We are located in the Flathead Valley, just a short drive to Glaciar National Park, Whitefish Mountain S ...
-
Realty Specialist
15 hours ago
Bonneville Power Administration Kalispell, United States Full timeAs a Realty Specialist, you will: · Participate in the public meeting process (noting landowner comments, answering questions regarding complex real estate issues, and provides support to the Project Team, etc.). Analyzes data and landowner comments received during the public mee ...
Scheduling and Prior Authorization Specialist - Whitefish, United States - Logan Health
Description
Job Description Summary:
This position is responsible for obtaining prior authorizations for all procedural orders by successfully completing the prior authorization process per department procedure and protocol.
Qualifications:
Job Specific Duties:
Shift:
Day Shift - Variable Hours (United States of America)
Schedule Details:
Please know schedules and shifts are subject to change based on patient care and department/organizational needs.
Schedule:
Logan Health operates 24 hours per day, seven days per week.
Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
Notice of Pre-Employment Screening RequirementsIf you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:
Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment.
We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability or any other basis protected by applicable law.
If you require accommodation to complete the application, testing or interview process, please notify Human Resources.The Planetree Culture at Logan Health - Whitefish
Thank you for your interest in Logan Health - Whitefish where we believe everyone who works at our hospital and clinics is a caregiver.
At Logan Health - Whitefish our employees are motivated by our open and supportive culture of caring for the patient and each other.
Logan Health - Whitefish was the first hospital in Montana to be affiliated with Planetree International, a non-profit organization setting the global standard for person-centered care.
As a Planetree affiliate, we embrace this evidence-based approach partnering with the patient and their family to provide the highest quality patient experience.
Logan Health - Whitefish is often recognized as one of the top critical access hospitals in the country and received a 5-star overall rating, the highest designation available for hospitals from the Centers for Medicare and Medicaid Services in 2023.
We take pride in providing our quality level of service and continuously work to go above and beyond our stellar reputation.
Our people are everything.The amazing providers, employees, and volunteers at Logan Health gift this organization with their innovation, knowledge, and compassion. Together, we're connecting our community to trusted, quality care and helping to improve lives every day.
Do you dream of living and working in a beautiful area surrounded by stunning scenery and endless recreation?
Are you ready to evolve your career while working alongside passionate, talented, brilliant people?
Join our remarkable team and create positive patient experiences every day
