Hennepin Healthcare
Prior Authorization Rep Sr, Financial Securing
Hennepin Healthcare, Minneapolis, Minnesota, United States, 55400
Summary
We are currently seeking a Prior Authorization Representative Senior to join our Financial Securing team. This full‑time role will primarily work remotely (Days M‑F).
Purpose of this position: The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating pre‑authorizations for patients and often handling cases that need quick turnaround (e.g., last‑minute scheduled services). The individual in this role is an expert on payer regulations and contracts, and they serve as a point of contact for peers looking to resolve questions or issues regarding prior authorizations.
Responsibilities
Utilizes online systems, phone communication, and other resources to secure prior authorizations within a timeframe before scheduled appointments/procedures/same day surgeries and during or after care for unscheduled patients
Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the provider/patient, as it pertains to prior authorization
Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed
Obtains pre‑certifications and prior authorizations from third‑party payers in accordance with payer requirements
Alerts physician offices to issues with verifying insurance and/or obtaining prior authorizations
Demonstrates expert understanding of insurance terminology (e.g., co‑payments, deductibles, allowances, etc.), and analyzes information received to determine patients' out‑of‑pocket liabilities, based on prior authorization status
Follows up on all prior authorization submissions for timely response
Follows up on any prior authorization denials; assists Utilization Management with appeals, as needed
Connects patients with financial counselors, as necessary
Maintains productivity and quality standards and assists other team members when necessary
Participates in developing and planning process improvements for the department
Other duties as assigned
Complies with all state and federal laws and regulations related to patient privacy and confidentiality
Minimum Qualifications
High school diploma or equivalent
2 years clerical experience in healthcare revenue cycle operations: billing/claims, patient accounting, collections, admissions, registration, etc.
Bilingual strongly preferred, required in some positions
OR – An approved equivalent combination of education and experience
Preferred Qualifications
Experience working in EPIC, preferred
Knowledge / Skills / Abilities
Knowledge of government and commercial payer (Insurance) benefit and eligibility verification, and ability to navigate medical policy per payer guidelines
Logical thinking, data preparation, and analysis
Comprehensive knowledge of Microsoft Office (Outlook, Word, Excel)
Strong communication skills, both verbal and written
Effective communication with collaborating departments, providers, and insurance representatives
Organizational skills and ability to prioritize and manage tasks based on established criteria
Excellent interpersonal skills
Ability to work independently with minimal supervision, within a team setting and be supportive of team members
Proficient with Microsoft Office
Ability to analyze issues and make judgments toward effective solutions
Seniority level Mid‑Senior level
Employment type Full‑time
Job function Health Care Provider
Industries Hospitals and Health Care
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Purpose of this position: The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating pre‑authorizations for patients and often handling cases that need quick turnaround (e.g., last‑minute scheduled services). The individual in this role is an expert on payer regulations and contracts, and they serve as a point of contact for peers looking to resolve questions or issues regarding prior authorizations.
Responsibilities
Utilizes online systems, phone communication, and other resources to secure prior authorizations within a timeframe before scheduled appointments/procedures/same day surgeries and during or after care for unscheduled patients
Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the provider/patient, as it pertains to prior authorization
Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed
Obtains pre‑certifications and prior authorizations from third‑party payers in accordance with payer requirements
Alerts physician offices to issues with verifying insurance and/or obtaining prior authorizations
Demonstrates expert understanding of insurance terminology (e.g., co‑payments, deductibles, allowances, etc.), and analyzes information received to determine patients' out‑of‑pocket liabilities, based on prior authorization status
Follows up on all prior authorization submissions for timely response
Follows up on any prior authorization denials; assists Utilization Management with appeals, as needed
Connects patients with financial counselors, as necessary
Maintains productivity and quality standards and assists other team members when necessary
Participates in developing and planning process improvements for the department
Other duties as assigned
Complies with all state and federal laws and regulations related to patient privacy and confidentiality
Minimum Qualifications
High school diploma or equivalent
2 years clerical experience in healthcare revenue cycle operations: billing/claims, patient accounting, collections, admissions, registration, etc.
Bilingual strongly preferred, required in some positions
OR – An approved equivalent combination of education and experience
Preferred Qualifications
Experience working in EPIC, preferred
Knowledge / Skills / Abilities
Knowledge of government and commercial payer (Insurance) benefit and eligibility verification, and ability to navigate medical policy per payer guidelines
Logical thinking, data preparation, and analysis
Comprehensive knowledge of Microsoft Office (Outlook, Word, Excel)
Strong communication skills, both verbal and written
Effective communication with collaborating departments, providers, and insurance representatives
Organizational skills and ability to prioritize and manage tasks based on established criteria
Excellent interpersonal skills
Ability to work independently with minimal supervision, within a team setting and be supportive of team members
Proficient with Microsoft Office
Ability to analyze issues and make judgments toward effective solutions
Seniority level Mid‑Senior level
Employment type Full‑time
Job function Health Care Provider
Industries Hospitals and Health Care
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