Prior Authorization Specialist - Milwaukee, United States - Gerald L. Ignace Indian Health Center, Inc.

Description

JOB SUMMARY**:

This position is primarily responsible for ensuring that prior authorizations are effectively and courteously processed for patients receiving services in the Gerald L.

Ignace Indian Health Center working directly with front office staff and providers.

ESSENTIAL
BEHAVIORS:
Build Trust**:Operate with transparency, no hidden agenda; place confidence in colleagues, give proper credit to others. Follow through on agreed upon actions. Treat sensitive or confidential information appropriately. Keep emotions under control. Exhibit ethical and moral behavior in everyday business conduct.


Foster
Communication:
Demonstrate ability to carefully listen to others at all levels of the organization. Seek and listen to feedback and be approachable. Express thoughts and ideas effectively. Display and promote cross cultural sensitivity.


Display Stewardship:
Understand business implications of decisions. Conserve organization resources. Look for ways to improve and promote quality. Take personal responsibility. Use resources in an efficient and cost-effective manner.

ESSENTIAL
DUTIES AND


RESPONSIBILITIES:
Prior Authorization Specialists are responsible for direct and indirect patient care activities, including but not limited to:

• Assist the Front Office staff with the daily pre-registration of patients scheduled for appointments. Proactively calls patients to inform them about any situation related to their medical insurance(s)
• Performs data entry of insurance information.
• Schedule and confirms medical appointments, reschedule, and cancel appointments if prior authorization is required and not in effect.
• Review scheduled appointments, verify insurance, and determine the need for prior authorizations.
• Work with providers to determine care plan and services to be provided under prior authorization.
• Develop and maintain records of all submitted requests for prior authorizations.
• Submit all services that require prior authorization to insurance carrier either online, phone or via fax.
• Develop and maintain a method to track prior authorization services and dates to eliminate risk of providing service(s) that exceed the limits of the authorization.
• Follow up on authorizations not received in a timely manner.
• When authorizations are received, enter authorization information into EHR.
• Monitor service(s) provided to be certain the billed service(s) matches the authorized service(s). Notify manager if there are discrepancies.
• Determine need for additional authorization and submit requests for continuing services if necessary.
• Complies with IHC, HIPAA and Privacy Rules.
• Uses efficient and clear communication at all times.
• Greets all patients in a friendly and professional manner including staff, vendors, providers, and community members.
• Maintains and organizes filing systems and is knowledgeable in the operation of office equipment and software programs.
• Asks for assistance if needed when directing incoming patients and visitors to the appropriate department or provider.
• Attends and participates in all departmental meetings.
• Maintains a current source of Front Office paperwork and forms. Keeps a clean, clutter free work area at all times.
• Participates as a proactive representative of the Patient Centered Health Home.
• Performs duties utilizing the Team-Based Approach.
• Performs other duties as assigned.

QUALIFICATIONS **(Education and Training):

• Requires a high school diploma or GED
• Prefer prior experience working in a medical/clinical setting with at least one year working experience.
• Experience processing prior authorizations.
• Incumbent will be trained on the different Front Office areas: Reception, Eligibility, and Phone Operations.
• Excellent customer service skills required
• Excellent phone skills required
• Previous knowledge of office practices and procedures in the behavioral health field preferred
• Must be knowledgeable and proficient with medical terminology.
• Ability to follow written and oral instructions
• Flexibility, initiative, reliability, and creativity
• Familiarity with medical computer software and data entry
• Experience using Microsoft Office software packages (Word, Excel, and PowerPoint)
• Experience working with Electronic Health Record systems, experience with EPIC is a plus.
• Knowledge of & ability to work with the American Indian community & other minority populations
• Ability to maintain strict confidentiality
• Ability to function independently and as a team member within diverse environments as well as with a diverse staff composition
• Demonstrated ability to perform multiple administrative functions simultaneously in an accurate, organized, & efficient manner. Ability to multitask & thrive in a fastpaced, constantly changing environment
• Ability to carry out all responsibilities in an honest, ethical & professional manner and demonstrate good judgment

OTHER
SIGNIFICANT **FACTORS*