Pre-Authorization Specialist 1-16927

Location: Chicago, Illinois

Business Unit: Rush Medical Center

Hospital: Rush University Medical Center

Department: Patient Access-Pre-Visit

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr (9:00:00 AM - 5:30:00 PM)

Rush offers exceptional rewards and benefits learn more at our Rush benefits page ).

Pay Range: $ $29.73 per hour

Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.

Summary
The Prior Authorization Specialist I is responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, ancillary and clinic/ambulatory environments. In addition, the Prior Authorization Specialist I may be responsible for pre-appointment registration and insurance review to maximize the submission of a clean claim. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.

Other Information
Required Job Qualifications:

• High school graduate or equivalent.
• 0-1 year of experience
• Must have a basic understanding of the core Microsoft suite offerings (Word, PowerPoint, Excel).
• Excellent communication and outstanding customer service and listing skills.
• Basic keyboarding skills
• Ability to analyze and interpret data
• Critical thinking, sound judgment and strong problem-solving skills essential
• Team oriented, open minded, flexible, and willing to learn
• Strong attention to detail and accuracy required
• Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
• Ability to follow oral and written instructions and established procedures
• Ability to function independently and manage own time and work tasks
• Ability to maintain accuracy and consistency
• Ability to maintain confidentiality

Preferred Job Qualifications

• Associates Degree in Accounting or Business Administration
• Experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service.
• Knowledge of insurance and governmental programs, regulations, and billing processes e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc., managed care contracts and coordination of benefits is highly desired.
• Working knowledge of medical terminology and anatomy and physiology is preferable.

Competencies
Physical Demands:

Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.

Responsibilities
Reviews, collects and properly records demographic and insurance information required to properly address the customers' authorization requirements and identify any financial issues. Verifies patient's eligibility from resources provided by third party payers and portals and other on lines services.

• Collects and analyzes demographic, insurance and other information from the patient, guarantor and all other sources to accurately obtain authorization for scheduled procedure.
• Assembles information concerning the patient's clinical background and clinical information that is required for the payer to issue a referral or an authorization. Per referral guidelines, provide appropriate clinical information to the payer.
• Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, CPT codes and clinical notes. Provide specific medical information to financial services to maximize reimbursement to the hospital and professional service providers.
• Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy and security Regulations, as well as JACHO.
• Consistently maintains authorization accuracy rates at and or above department standard in performance of registration and authorization duties.
• Customers. Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
• Interacts and collaborates with numerous departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
• Appropriately informs the patients of hospital policies that govern the revenue cycle, the amount owed by the patients and explains hospital