Prior Authorization Specialist

ABOUT SHERIDAN MEMORIAL HOSPITAL

At Sheridan Memorial Hospital, we are proud to have achieved the 5-Star Quality Rating, ranking us in the top 13.6% of hospitals rated by the Centers for Medicare and Medicaid Services. We believe that our ability to deliver excellent healthcare begins with our people, and we are proud of our more than 750 skilled, experienced, and caring employees. We have over 100 providers who specialize in 25 areas of expertise. Our facility is state-of-the-art, and we are dedicated to providing outstanding patient-centered care.

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Nestled at the foothills of the Big Horn Mountains in northern Wyoming, spectacular scenery and outdoor activities abound. Our hospital has the latest technology and equipment comparative to that of many larger facilities, and you will find our staff is friendly, compassionate, caring, and courteous. We focus on creating and nurturing a workplace that encourages, recognizes, and rewards individual effort and creativity. Leadership is responsive to changing modes of healthcare delivery and adapts accordingly. We value effective communication and honesty and believe teamwork based on mutual respect is key to success.

JOB SUMMARY:

Service excellence and a culture of kindness are priorities for Sheridan Memorial Hospital and must be maintained while providing personalized attention in a professional manner recognizing individual needs and concerns. The duties required include pre-authorization of services performed within the hospital and clinics per payor guidelines in timely manner.

ESSENTIAL JOB FUNCTIONS:

• Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.


• Verifies physician orders are accurate, determines CPT, HCPCS and ICD-10 codes for proper Prior Authorization.


• Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections.


• Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.


• Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.


• Helps to maintain a professional atmosphere for patients, family members and staff.


• Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.


• Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.

POSITION QUALIFICATIONS

Education / Experience / License and Certifications

• High school graduate or equivalent.


• Knowledge of CPT, HCPCS, and ICD-10 codes preferred.


• Medical terminology required.

Additional Skills

• Ability to read, analyzes, interprets, and communicate effectively in English.


• Ability to effectively present information and respond to questions from providers, clinical staff, payors, and patients.


• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.


• Ability to interpret a variety of instructions furnished in written, oral, or scheduled form.Proficient with MS Office Suite including Word, Excel and PowerPoint.


• Proficient with the EMR system.


• Ability to solve conflict.


• Must possess excellent time management and organization skills with attention to detail.


• Demonstrates critical thinking, creativity, and problem-solving.


• Demonstrates the ability to maintain confidentiality.


• Ability to write clearly and informatively.


• Ability to cope with stressful situations and maintain a calm and professional demeanor.


• Ability to prioritize and perform multiple tasks with many interruptions.