Prior Authorization Specialist - St. Croix Regional Medical Center : Job Details

ApplyJob TypeFull-timeDescriptionSt. Croix Health is looking for a full-time (1.0 FTE) Prior Authorization Specialist to join our Business Office team! This position will work Monday - Friday, day hours.Training will take place on-site (at St. Croix Falls, Wisconsin location). Once fully trained, remote work considered. Remote employees are required to live within a commutable distance from our primary location in St. Croix Falls as on-site meetings and trainings are required.Job Summary:The Prior Authorization Specialist is responsible for coordinating, prioritizing, and monitoring the day-to-day operational activities of verifying insurance benefits as it applies to obtaining precertification/preauthorization from payers for 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 and testing, inpatient/observation admissions, and physical/occupational/speech/cardiac rehab.Essential Duties and Responsibilities:* Prepares, organizes, prioritizes, documents and communicates all necessary paperwork and information needed by insurance companies for the prior authorization process.* Verifies provider orders, patient eligibility and submission process per payer* Completes tasks independently in a timely manner for prior authorization* Minimal denials due to prior authorizations accuracy* Serves as a resource and liaison for staff and patient2. Pursues and maintains a strong working relationship with all payer groups* Continuously researches and stays updated on payer requirements for prior authorization* Shares information with appropriate staff* Updates tip sheets when appropriate3. Verifies benefits, including medical necessity and communicates finding with appropriate department and/or patient. Acts as a resource and liaison to staff and patient regarding medical necessity and prior authorization issues* Insures all necessary information regarding prior authorization is documented in Epic appropriately* Responds to patient concerns and questions timely and insures understanding* Works collaboratively with all departments to resolve concerns and questionsRequirementsEducation & Licensure:* High School diploma/GEDExperience:* 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 preferredKnowledge, Skills & Abilities:* Excellent communication and listening skills* Demonstrated ability to work independently with little direction and manage multiple demands and prioritiesPhysical Requirements:* Prolonged periods of sitting at a desk and working on a computer.* Must be able to lift up to 15 pounds at times.St. Croix Health is an Equal Opportunity Employer.St. Croix Health has been a healing force in the St. Croix Valley for over 103 years. We are a purpose-driven organization with a dedicated team committed to serving our patients and communities throughout the St. Croix Valley. This commitment is rooted in our mission, vision and values.Mission: We help people live healthier, happier, and longer lives.Vision: To transform from quality sick care to quality well care that is sustainable and affordable.Values: People Centered, Trust, Innovation, and Growth.Here at St. Croix Health we offer our employees with a robust benefits package that includes:* Health, vision and dental insurance* 403b retirement program with employer match* Paid time off* Short-term disability, long-term disability and life insurance options* Education reimbursement* Employee assistance program (EAP)* Wellbeing incentive program* Free parking* Employee prescription discount programSt. Croix Health is a not-for-profit healthcare system located in St. Croix Falls, WI dedicated to helping people live healthier, happier, and longer lives. St. Croix Health offers the services of 80+ providers and 20 specialties with five community clinics in Minnesota and Wisconsin all supported by a critical access hospital on the main campus in St. Croix Falls, just an hour northeast of Minneapolis/St. Paul. Nestled in the bluffs of the St. Croix River Valley, St. Croix Falls is the ideal place to work, live and play.