Mason Health
Prior Authorization Specialist:
This 1.0 FTE/Full-time position is scheduled for 8-HR day shifts and is UFCW represented.
Compensation : Non-exempt, $21.31/HR - $34.43/HR
Benefits:
At Mason Health, we are committed to providing our employees with a comprehensive benefits package that supports both your professional growth and personal well-being. Whether you are a Part-time or Full-time member:
Health & Wellness Benefits: Medical, Dental & Vision Insurance - With employer paid premiums for full-time employees Mental Health & Wellness Resources - Access to our Employee Assistance Program (EAP), Talkspace, and the Calm App. Life Insurance Short & Long-Term Disability Insurance Financial Benefits:
Retirement/Deferred Compensation Plans - Mason Health contributes 8% of your compensation every pay period when you contribute at least 5%. Flexible Spending Account (FSA) Tuition Assistance Program Approved by the Health Resources and Services Administration (HRSA) for student loan repayment programs. Time Off & Work-Life Balance:
Generous Paid Time Off (PTO) - Accrue up to 8 hours of PTO every bi-weekly pay period, starting with 5 weeks of PTO and increasing to 7+ weeks after 3 years. Exciting Incentive:
Employee Referral Program - Earn up to $7,500 depending on the role. PNW Living:
Nestled in the heart of the Pacific
Northwest
- Shelton offers the perfect balance of work and lifestyle, with access to top outdoor recreation, local dining, and unique attractions. Located near Olympic National Park and Puget Sound, it's a gateway to adventure, surrounded by lush evergreen forests, crisp mountain air, and serene waters.
Job Summary: The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for surgical, ambulatory care, wound care and other procedures and medications. Responsible for collecting demographic data and insurance information for scheduled patients, verifying insurance eligibility, obtaining prior authorization, identifying copay information, and referring patients for financial assistance with Business office IPA as needed. Reviews completeness and accuracy of insurance information entered by scheduling and referrals staff. Analyzes, researches, and resolves prior authorization processing issues, including making written or telephone inquiries to obtain information from providers, payors and patients. Provides a "Patients First" experience and supports a positive workplace by maintaining a professional work environment while completing all assigned tasks in a timely and accurate manner. May provide relief coverage in hospital registration areas as needed.
Essential Duties and Responsibilities: Reviews Authorization and Scheduling work pools daily for services or medications requiring authorizations, pre-notification, and insurance eligibility verification. Requests, tracks, and obtains pre-authorization from insurance carriers within time allotted for medication and services. Obtains required authorizations prior to services via phone, fax, on-line, etc. and ensures authorization of services are current and quantity and type of service provided meet payor requirements. Performs initial verification of insurance eligibility and benefits, identifies deductibles, co-pays, and self-pay accounts. Coordinates with IPA (Financial Counseling) any necessary information for patient financial discussions. Coordinates with scheduling departments and Pharmacists to ensure all documentation (including referrals, H&P, clinical and medical necessity documentation) is available for submission to expedite prior authorization process. Review accuracy and completeness of information requested and ensure that all supporting documents are present. Manages correspondence with partner departments, payors, ordering providers, and patients as needed, including thorough documenting in the EMR and work pools as appropriate. Inputs and updates authorization information into EMR and work pools; clearly documenting all communications and contacts with payors, providers, and personnel in standardized documentation requirements, including proper format. Notifies the appropriate staff members if treatment or service is denied. Works with providers and partner department's if peer-to-peer review is necessary. Works with Business office staff to support appeal efforts for authorization-related denials. Obtains retro authorizations in a timely manner. Monitors existing authorizations on all recurring encounters and re-verify monthly for authorization and insurance eligibility and benefits. Other pre-service and registration duties as assigned. Other duties as assigned. Required Education and Experience:
High school diploma or equivalent. Minimum two (2) years processing prior authorization, insurance verification and referrals. Experience in a hospital setting preferred. Required Knowledge, Skills and Abilities:
Strong understanding of medical terminology and insurance policies. Demonstrated knowledge of clinical ICD10, CPT, and HCPCS Knowledge of HIPAA regulations and requirements; ability to apply regulations and policies as required to ensure proper handling of confidential patient records and to explain the law and our privacy policy to patients. Demonstrated high level of accuracy and attention to detail. Ability to mentor other patient access staff to help improve individual knowledge and provide quality outcomes as evidenced by reduction in denials and routine audits. Ability to work in a self-directed manner to accomplish assigned tasks in accordance with District policies and procedures. Ability to follow directions and to work quickly and efficiently in an environment that includes varying workloads and interruptions. Ability to work collaboratively with co-workers and providers. Proficient in the use of current technology, including Microsoft Office products. Demonstrated keyboarding and data entry skills and ability to enter data quickly and accurately. Type >40 WPM Professional and effective written and verbal communication skills. Ability to communicate effectively with patients, co-workers, and providers and to maintain composure in stressful circumstances. Ability to follow established protocols, key understanding of urgent/emergent guidelines and scenarios.
Mason Health practices equal employment opportunity towards all workforce members and applicants for employment. Mason Health does not engage in or tolerate any discrimination in the workplace prohibited by applicable local, state, or federal law. Specifically, no workforce member will be discriminated against on the basis of their race, color, sex/gender (including pregnancy), sexual orientation, religion/creed, age, disability, marital or veteran status, national origin, genetic information, or any other characteristic protected by applicable state or federal law.
This 1.0 FTE/Full-time position is scheduled for 8-HR day shifts and is UFCW represented.
Compensation : Non-exempt, $21.31/HR - $34.43/HR
Benefits:
At Mason Health, we are committed to providing our employees with a comprehensive benefits package that supports both your professional growth and personal well-being. Whether you are a Part-time or Full-time member:
Health & Wellness Benefits: Medical, Dental & Vision Insurance - With employer paid premiums for full-time employees Mental Health & Wellness Resources - Access to our Employee Assistance Program (EAP), Talkspace, and the Calm App. Life Insurance Short & Long-Term Disability Insurance Financial Benefits:
Retirement/Deferred Compensation Plans - Mason Health contributes 8% of your compensation every pay period when you contribute at least 5%. Flexible Spending Account (FSA) Tuition Assistance Program Approved by the Health Resources and Services Administration (HRSA) for student loan repayment programs. Time Off & Work-Life Balance:
Generous Paid Time Off (PTO) - Accrue up to 8 hours of PTO every bi-weekly pay period, starting with 5 weeks of PTO and increasing to 7+ weeks after 3 years. Exciting Incentive:
Employee Referral Program - Earn up to $7,500 depending on the role. PNW Living:
Nestled in the heart of the Pacific
Northwest
- Shelton offers the perfect balance of work and lifestyle, with access to top outdoor recreation, local dining, and unique attractions. Located near Olympic National Park and Puget Sound, it's a gateway to adventure, surrounded by lush evergreen forests, crisp mountain air, and serene waters.
Job Summary: The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for surgical, ambulatory care, wound care and other procedures and medications. Responsible for collecting demographic data and insurance information for scheduled patients, verifying insurance eligibility, obtaining prior authorization, identifying copay information, and referring patients for financial assistance with Business office IPA as needed. Reviews completeness and accuracy of insurance information entered by scheduling and referrals staff. Analyzes, researches, and resolves prior authorization processing issues, including making written or telephone inquiries to obtain information from providers, payors and patients. Provides a "Patients First" experience and supports a positive workplace by maintaining a professional work environment while completing all assigned tasks in a timely and accurate manner. May provide relief coverage in hospital registration areas as needed.
Essential Duties and Responsibilities: Reviews Authorization and Scheduling work pools daily for services or medications requiring authorizations, pre-notification, and insurance eligibility verification. Requests, tracks, and obtains pre-authorization from insurance carriers within time allotted for medication and services. Obtains required authorizations prior to services via phone, fax, on-line, etc. and ensures authorization of services are current and quantity and type of service provided meet payor requirements. Performs initial verification of insurance eligibility and benefits, identifies deductibles, co-pays, and self-pay accounts. Coordinates with IPA (Financial Counseling) any necessary information for patient financial discussions. Coordinates with scheduling departments and Pharmacists to ensure all documentation (including referrals, H&P, clinical and medical necessity documentation) is available for submission to expedite prior authorization process. Review accuracy and completeness of information requested and ensure that all supporting documents are present. Manages correspondence with partner departments, payors, ordering providers, and patients as needed, including thorough documenting in the EMR and work pools as appropriate. Inputs and updates authorization information into EMR and work pools; clearly documenting all communications and contacts with payors, providers, and personnel in standardized documentation requirements, including proper format. Notifies the appropriate staff members if treatment or service is denied. Works with providers and partner department's if peer-to-peer review is necessary. Works with Business office staff to support appeal efforts for authorization-related denials. Obtains retro authorizations in a timely manner. Monitors existing authorizations on all recurring encounters and re-verify monthly for authorization and insurance eligibility and benefits. Other pre-service and registration duties as assigned. Other duties as assigned. Required Education and Experience:
High school diploma or equivalent. Minimum two (2) years processing prior authorization, insurance verification and referrals. Experience in a hospital setting preferred. Required Knowledge, Skills and Abilities:
Strong understanding of medical terminology and insurance policies. Demonstrated knowledge of clinical ICD10, CPT, and HCPCS Knowledge of HIPAA regulations and requirements; ability to apply regulations and policies as required to ensure proper handling of confidential patient records and to explain the law and our privacy policy to patients. Demonstrated high level of accuracy and attention to detail. Ability to mentor other patient access staff to help improve individual knowledge and provide quality outcomes as evidenced by reduction in denials and routine audits. Ability to work in a self-directed manner to accomplish assigned tasks in accordance with District policies and procedures. Ability to follow directions and to work quickly and efficiently in an environment that includes varying workloads and interruptions. Ability to work collaboratively with co-workers and providers. Proficient in the use of current technology, including Microsoft Office products. Demonstrated keyboarding and data entry skills and ability to enter data quickly and accurately. Type >40 WPM Professional and effective written and verbal communication skills. Ability to communicate effectively with patients, co-workers, and providers and to maintain composure in stressful circumstances. Ability to follow established protocols, key understanding of urgent/emergent guidelines and scenarios.
Mason Health practices equal employment opportunity towards all workforce members and applicants for employment. Mason Health does not engage in or tolerate any discrimination in the workplace prohibited by applicable local, state, or federal law. Specifically, no workforce member will be discriminated against on the basis of their race, color, sex/gender (including pregnancy), sexual orientation, religion/creed, age, disability, marital or veteran status, national origin, genetic information, or any other characteristic protected by applicable state or federal law.