Prior Authorization Specialist - Rehab Services in Mora, Minnesota at Welia Health

Summary
Responsible for assisting with: Obtaining Prior Authorizations for scheduled services at Welia Health in accordance with the payer-provider contract. The Prior Authorizations Specialist contacts payers to request services authorization.

Essential Duties & Responsibilities include the following. Other duties may be assigned.

• Verify patients' insurance and benefit information.
• Obtains prior authorization from third-party payers in accordance with payer requirements.
• Obtain authorizations for procedures for Workers Compensation patients
• Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
• Works with other departments to gather the clinical information required by the payer to authorize services.
• Keep accurate records of authorizations within the EMR.
• Communicates with scheduling staff after prior authorization is obtained.
• Communicates with Patient Services Representative if prior authorization is not obtained.
• Works with business office staff to support appeal efforts for authorization-related denials.
• Promote service excellence by demonstrating polite, cooperative and respectful behavior to both internal and external customers.
• Assume responsibility for completing mandatory educational requirements.
• Safeguard security and confidentiality of data/information according to HIPAA guidelines.

Computer Skills
Knowledge of Microsoft office products, ability and willingness to learn new software products as needed

Education and/or Experience
Associate’s degree in healthcare or business administration and/or related coursework or comparable experience of minimum of 2 years in a related healthcare field such as coding, billing, nursing etc. Must have excellent customer service and communication skills along with computer and clerical skills.

• Familiar with medical terminology and healthcare insurance processes
• Ability to work independently with strong attention to detail.
• Ability to prioritize and multitask
• Ability to perform routine and complex procedures
• Ability to recognize problems, identify the cause and implement the solution

Welia Health is an equal opportunity employer.