FinThrive
Prior Authorization Rules Analyst
FinThrive, Plano, Texas, United States, 75024
About FinThrive
FinThrive is advancing the healthcare economy.For the most recent information on FinThrive's vision for healthcare revenue management visit finthrive.com/why-finthrive.
Award-winning Culture of Customer-centricity and Reliability
At FinThrive we're proud of our agile and committed culture, which makes FinThrive an exceptional place to work. Explore our latest workplace recognitions at careers#culture.
Our Perks and Benefits
FinThrive is committed to continually enhancing the colleague experience by actively seeking new perks and benefits. For the most up-to-date offerings visit finthrive.com/careers-benefits.
About the Role
Impact you will make
As a Prior Authorization Rules Analyst, you will be responsible for management of global rules to inform when prior authorization is required. This will include prioritization of work queues for an offshore team, updated policy document analysis to ensure accuracy of loaded rules, and process definition and refinement. In addition, you will be the primary interface with payer representatives.
What you will do
Understand and contribute to analysis of payer policy documents and loading related requirements for Prior Authorization
Manage work queue for offshore team
Contribute to education and documentation for internal stakeholders and external customers on intricacies of payer authorization requirements
Collaboration with product team for definition and prioritization of payer ruleset related functionality
Maintain payer relationships
What you will bring
Bachelor's degree or equivalent similar work experience
3+ years of experience working with Prior Authorizations and payer authorization requirements
Clinical knowledge relevant to Correct Coding guidelines (NCCI)
Motivation to make a difference, comfort in communicating where you see opportunities for improvement
Ability to prioritize and manage multiple projects to critical timelines in a fast-paced environment
Confident, clear communication both at a technical and nontechnical level
Ability to work in or lead small, highly focused teams as necessary
Ability to work independently with minimal supervision
What we would like to see
National Correct Coding Initiative (NCCI) experience
Experience interfacing with partner organizations
Experience with healthcare software, particularly relating to Prior Authorizations in a Patient Access team
FinThrive's Core Values and Expectations
Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to FinThrive's core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the FinThrive environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
Support FinThrive's Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to FinThrive's business practices; this includes becoming familiar with FinThrive's Code of Ethics, attending training as required, notifying management or FinThrive's Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
Physical Demands
The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Statement of EEOFinThrive values diversity and belonging and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're committed to providing reasonable accommodation for qualified applicants with disabilities in our job application and recruitment process.
FinThrive Privacy Notice for California Resident Job Candidates
Know Your RightsPay Transparency Notice
FinThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.2024 FinThrive. All rights reserved. The FinThrive name, products, associated trademarks and logos are owned by FinThrive or related entities. RV092724TJO
finthrive.com
|
FinThrive Careers
|
FinThrive Benefits & Perks
|
Physical Demands
FinThrive is advancing the healthcare economy.For the most recent information on FinThrive's vision for healthcare revenue management visit finthrive.com/why-finthrive.
Award-winning Culture of Customer-centricity and Reliability
At FinThrive we're proud of our agile and committed culture, which makes FinThrive an exceptional place to work. Explore our latest workplace recognitions at careers#culture.
Our Perks and Benefits
FinThrive is committed to continually enhancing the colleague experience by actively seeking new perks and benefits. For the most up-to-date offerings visit finthrive.com/careers-benefits.
About the Role
Impact you will make
As a Prior Authorization Rules Analyst, you will be responsible for management of global rules to inform when prior authorization is required. This will include prioritization of work queues for an offshore team, updated policy document analysis to ensure accuracy of loaded rules, and process definition and refinement. In addition, you will be the primary interface with payer representatives.
What you will do
Understand and contribute to analysis of payer policy documents and loading related requirements for Prior Authorization
Manage work queue for offshore team
Contribute to education and documentation for internal stakeholders and external customers on intricacies of payer authorization requirements
Collaboration with product team for definition and prioritization of payer ruleset related functionality
Maintain payer relationships
What you will bring
Bachelor's degree or equivalent similar work experience
3+ years of experience working with Prior Authorizations and payer authorization requirements
Clinical knowledge relevant to Correct Coding guidelines (NCCI)
Motivation to make a difference, comfort in communicating where you see opportunities for improvement
Ability to prioritize and manage multiple projects to critical timelines in a fast-paced environment
Confident, clear communication both at a technical and nontechnical level
Ability to work in or lead small, highly focused teams as necessary
Ability to work independently with minimal supervision
What we would like to see
National Correct Coding Initiative (NCCI) experience
Experience interfacing with partner organizations
Experience with healthcare software, particularly relating to Prior Authorizations in a Patient Access team
FinThrive's Core Values and Expectations
Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to FinThrive's core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the FinThrive environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
Support FinThrive's Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to FinThrive's business practices; this includes becoming familiar with FinThrive's Code of Ethics, attending training as required, notifying management or FinThrive's Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
Physical Demands
The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Statement of EEOFinThrive values diversity and belonging and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're committed to providing reasonable accommodation for qualified applicants with disabilities in our job application and recruitment process.
FinThrive Privacy Notice for California Resident Job Candidates
Know Your RightsPay Transparency Notice
FinThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.2024 FinThrive. All rights reserved. The FinThrive name, products, associated trademarks and logos are owned by FinThrive or related entities. RV092724TJO
finthrive.com
|
FinThrive Careers
|
FinThrive Benefits & Perks
|
Physical Demands