Minnesota Staffing
Prior Authorization Specialist
Minnesota Staffing, Saint Paul, Minnesota, United States, 55130
Full Time Prior Authorization Specialist
Gillette Children's is recruiting a Full Time Prior Authorization Specialist, 1.0 FTE (40 hrs/wk); Monday Friday, business hours. This position requires initial on-site training at the River Park Plaza location in St. Paul, and then will transition to a remote working role. However, the selected candidate must reside in Minnesota or Wisconsin and have the ability to work onsite in St. Paul, MN as needed. This position exists to facilitate the processing of authorizations, certifications and referrals needed by payers in order to allow reimbursement at the highest levels for both the patients and for the organization. Utilize available resources to check patient insurance benefits and eligibility to better inform our patients of their estimated financial liability. Compensation & Benefits: The hourly wage for this opportunity is $21.00/hour to $30.27/hour, with a median wage of $25.22/hour. Pay is dependent on several factors including relevant work experience, education, certification & licensure, and internal equity. Hourly pay is just one part of the compensation package for employees. Gillette supports career progression and offers a competitive benefits package that includes a retirement savings match, tuition and certification reimbursement, paid time off, and health and wellness benefits for 0.5 FTE and above. Core Responsibilities and Duties
Authorization Review + Knowledge of commercial and government payor regulatory requirements, timely filing guidelines + Provides feedback to analysts and/or leader when barriers arise with obtaining approval + Meets and maintains quality and productivity metrics as well as Gillette CARES values as set by the department Account Follow-Up + Demonstrates understanding and ability to apply patient account policies and procedures + Timely follow-up on outstanding authorization requests + Works with peers and analysts as necessary to resolve claim issues + Works with analysts and other departments to file authorization appeals Technology, Policies and Procedures + Demonstrates competency in organizational systems including: Cerner Revenue Cycle, Access Management, Change Healthcare, eDOCS, online resources and other relevant technology Critical Thinking + Takes ownership of patient experience by ensuring authorizations are approved within a timely fashion and patient/family is made aware of any issues due to authorization + Demonstrates critical thinking with hand-offs. Know who, when and how + Follows through on situations and tasks through completion Qualifications
Required: + High School Diploma/ GED + 1 year experience in customer service, administrative, or healthcare setting Preferred: + Advanced education (Associate or Bachelor's) + Previous Prior Authorization or Revenue Cycle (Registration, Billing, Coding) experience Knowledge, Skills and Abilities
+ Knowledge & understanding of medical terminology + Knowledge & understanding of commercial insurance carriers and standard insurance forms + Knowledge of payor authorization requirements and timely filing guidelines + Strong computer aptitude including knowledge of Microsoft Office (Word, Excel, Outlook) + Demonstrated strength in customer service, organization, attention to detail and the ability to work independently and as a team + Demonstrated ability to work and problem solve in a collaborative manner within the department and organization + Demonstrated ability to multi-task and respond quickly/reprioritize changing needs At Gillette Children's, we foster a culture where every team member feels a sense of belonging and purpose. We are dedicated to building an environment where all feel welcomed, respected, and supported. Our values are embedded at the heart of our culture. We act first from love, embrace the bigger picture, and work side-by-side with our patients, families, and colleagues to help every child create their own story. Together, we work to ensure patients of all backgrounds and abilities reach their full potential. Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws. Gillette Children's is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses.
Gillette Children's is recruiting a Full Time Prior Authorization Specialist, 1.0 FTE (40 hrs/wk); Monday Friday, business hours. This position requires initial on-site training at the River Park Plaza location in St. Paul, and then will transition to a remote working role. However, the selected candidate must reside in Minnesota or Wisconsin and have the ability to work onsite in St. Paul, MN as needed. This position exists to facilitate the processing of authorizations, certifications and referrals needed by payers in order to allow reimbursement at the highest levels for both the patients and for the organization. Utilize available resources to check patient insurance benefits and eligibility to better inform our patients of their estimated financial liability. Compensation & Benefits: The hourly wage for this opportunity is $21.00/hour to $30.27/hour, with a median wage of $25.22/hour. Pay is dependent on several factors including relevant work experience, education, certification & licensure, and internal equity. Hourly pay is just one part of the compensation package for employees. Gillette supports career progression and offers a competitive benefits package that includes a retirement savings match, tuition and certification reimbursement, paid time off, and health and wellness benefits for 0.5 FTE and above. Core Responsibilities and Duties
Authorization Review + Knowledge of commercial and government payor regulatory requirements, timely filing guidelines + Provides feedback to analysts and/or leader when barriers arise with obtaining approval + Meets and maintains quality and productivity metrics as well as Gillette CARES values as set by the department Account Follow-Up + Demonstrates understanding and ability to apply patient account policies and procedures + Timely follow-up on outstanding authorization requests + Works with peers and analysts as necessary to resolve claim issues + Works with analysts and other departments to file authorization appeals Technology, Policies and Procedures + Demonstrates competency in organizational systems including: Cerner Revenue Cycle, Access Management, Change Healthcare, eDOCS, online resources and other relevant technology Critical Thinking + Takes ownership of patient experience by ensuring authorizations are approved within a timely fashion and patient/family is made aware of any issues due to authorization + Demonstrates critical thinking with hand-offs. Know who, when and how + Follows through on situations and tasks through completion Qualifications
Required: + High School Diploma/ GED + 1 year experience in customer service, administrative, or healthcare setting Preferred: + Advanced education (Associate or Bachelor's) + Previous Prior Authorization or Revenue Cycle (Registration, Billing, Coding) experience Knowledge, Skills and Abilities
+ Knowledge & understanding of medical terminology + Knowledge & understanding of commercial insurance carriers and standard insurance forms + Knowledge of payor authorization requirements and timely filing guidelines + Strong computer aptitude including knowledge of Microsoft Office (Word, Excel, Outlook) + Demonstrated strength in customer service, organization, attention to detail and the ability to work independently and as a team + Demonstrated ability to work and problem solve in a collaborative manner within the department and organization + Demonstrated ability to multi-task and respond quickly/reprioritize changing needs At Gillette Children's, we foster a culture where every team member feels a sense of belonging and purpose. We are dedicated to building an environment where all feel welcomed, respected, and supported. Our values are embedded at the heart of our culture. We act first from love, embrace the bigger picture, and work side-by-side with our patients, families, and colleagues to help every child create their own story. Together, we work to ensure patients of all backgrounds and abilities reach their full potential. Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws. Gillette Children's is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses.