St. Croix Health
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Prior Authorization Specialist – St. Croix Health Full‑time (1.0 FTE). Monday – Friday, day hours. Training on site in St. Croix Falls, Wisconsin. After training, remote work is considered. Remote employees must reside within a commutable distance of St. Croix Falls for onsite days, meetings, and trainings.
Job Summary Coordinate, prioritize, and monitor day‑to‑day operational activities of verifying insurance benefits for prior authorization of specialty medications, in‑clinic procedures, podiatry orthotics, surgery, pain management injections, high‑tech radiology (MRI, CT, Echo, Nuc Med), home and in‑lab sleep studies, behavioral health visits, testing, inpatient/observation admissions, and physical/occupational/speech/cardiac rehab.
Essential Duties and Responsibilities
Prepare, organize, prioritize, document and communicate all necessary paperwork and information needed by insurance companies for the prior authorization process.
Verify provider orders, patient eligibility and submission process per payer.
Complete tasks independently in a timely manner for prior authorization.
Maintain minimal denials due to prior authorization accuracy.
Serve as a resource and liaison for staff and patients.
Pursue and maintain a strong working relationship with all payer groups.
Continuously research and keep up‑to‑date on payer requirements for prior authorization.
Share information with appropriate staff.
Update tip sheets when appropriate.
Verify benefits, including medical necessity, and communicate findings with appropriate department and/or patient. Act as a resource and liaison to staff and patient regarding medical necessity and prior authorization issues.
Ensure all necessary information regarding prior authorization is documented in Epic appropriately.
Respond to patient concerns and questions timely and reinforce understanding.
Work collaboratively with all departments to resolve concerns and questions.
Requirements Education & Licensure
High school diploma / GED.
Experience
3+ years of medical customer service OR 2+ years of experience in healthcare with insurance and/or prior authorization required.
Previous experience working with insurance and third‑party payers preferred.
Previous experience with CPT and ICD‑10 coding required.
Formal coursework in medical terminology OR previous experience with medical terminology required.
Prior recent EPIC/Excellian experience preferred.
Knowledge, Skills & Abilities
Excellent communication and listening skills.
Demonstrated ability to work independently with little direction and manage multiple demands and priorities.
Physical Requirements
Prolonged periods of sitting at a desk and working on a computer.
Prolonged periods of standing, bending, and reaching.
Must be able to lift up to 15 pounds at times.
Equal Opportunity Employer St. Croix Health is an Equal Opportunity Employer. We provide reasonable accommodations for persons with disabilities during the hiring process. If accommodations are needed, please contact HR@scrmc.org or 800‑828‑3627.
About St. Croix Health St. Croix Health has been a healing force in the St. Croix Valley for over 103 years. We are a purpose‑driven organization committed to serving patients and communities throughout the valley. Our mission is to help people live healthier, happier, and longer lives. Our vision is to transform from quality sick care to quality well‑care that is sustainable and affordable. Our values are People‑Centered, Trust, Innovation, and Growth.
Benefits
Health, vision and dental insurance
403(b) retirement program with employer match
Paid time off
Short‑term disability, long‑term disability and life insurance options
Education reimbursement
Employee assistance program (EAP)
Well‑being incentive program
Free parking
Employee prescription discount program
Location St. Croix Falls, WI (on‑site; remote work considered). Remote employees must live within a commutable distance from the St. Croix Falls location for onsite days, meetings, and trainings.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Other
Industries Medical Practices
Referrals increase your chances of interviewing at St. Croix Health by 2x.
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Prior Authorization Specialist – St. Croix Health Full‑time (1.0 FTE). Monday – Friday, day hours. Training on site in St. Croix Falls, Wisconsin. After training, remote work is considered. Remote employees must reside within a commutable distance of St. Croix Falls for onsite days, meetings, and trainings.
Job Summary Coordinate, prioritize, and monitor day‑to‑day operational activities of verifying insurance benefits for prior authorization of specialty medications, in‑clinic procedures, podiatry orthotics, surgery, pain management injections, high‑tech radiology (MRI, CT, Echo, Nuc Med), home and in‑lab sleep studies, behavioral health visits, testing, inpatient/observation admissions, and physical/occupational/speech/cardiac rehab.
Essential Duties and Responsibilities
Prepare, organize, prioritize, document and communicate all necessary paperwork and information needed by insurance companies for the prior authorization process.
Verify provider orders, patient eligibility and submission process per payer.
Complete tasks independently in a timely manner for prior authorization.
Maintain minimal denials due to prior authorization accuracy.
Serve as a resource and liaison for staff and patients.
Pursue and maintain a strong working relationship with all payer groups.
Continuously research and keep up‑to‑date on payer requirements for prior authorization.
Share information with appropriate staff.
Update tip sheets when appropriate.
Verify benefits, including medical necessity, and communicate findings with appropriate department and/or patient. Act as a resource and liaison to staff and patient regarding medical necessity and prior authorization issues.
Ensure all necessary information regarding prior authorization is documented in Epic appropriately.
Respond to patient concerns and questions timely and reinforce understanding.
Work collaboratively with all departments to resolve concerns and questions.
Requirements Education & Licensure
High school diploma / GED.
Experience
3+ years of medical customer service OR 2+ years of experience in healthcare with insurance and/or prior authorization required.
Previous experience working with insurance and third‑party payers preferred.
Previous experience with CPT and ICD‑10 coding required.
Formal coursework in medical terminology OR previous experience with medical terminology required.
Prior recent EPIC/Excellian experience preferred.
Knowledge, Skills & Abilities
Excellent communication and listening skills.
Demonstrated ability to work independently with little direction and manage multiple demands and priorities.
Physical Requirements
Prolonged periods of sitting at a desk and working on a computer.
Prolonged periods of standing, bending, and reaching.
Must be able to lift up to 15 pounds at times.
Equal Opportunity Employer St. Croix Health is an Equal Opportunity Employer. We provide reasonable accommodations for persons with disabilities during the hiring process. If accommodations are needed, please contact HR@scrmc.org or 800‑828‑3627.
About St. Croix Health St. Croix Health has been a healing force in the St. Croix Valley for over 103 years. We are a purpose‑driven organization committed to serving patients and communities throughout the valley. Our mission is to help people live healthier, happier, and longer lives. Our vision is to transform from quality sick care to quality well‑care that is sustainable and affordable. Our values are People‑Centered, Trust, Innovation, and Growth.
Benefits
Health, vision and dental insurance
403(b) retirement program with employer match
Paid time off
Short‑term disability, long‑term disability and life insurance options
Education reimbursement
Employee assistance program (EAP)
Well‑being incentive program
Free parking
Employee prescription discount program
Location St. Croix Falls, WI (on‑site; remote work considered). Remote employees must live within a commutable distance from the St. Croix Falls location for onsite days, meetings, and trainings.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Other
Industries Medical Practices
Referrals increase your chances of interviewing at St. Croix Health by 2x.
Get notified about new Specialist jobs in St. Croix Falls, WI.
#J-18808-Ljbffr