Trinity Health
Prior Authorization Specialist
Trinity Health, Grand Rapids, Michigan, us, 49528
Employment Type:Full time
Shift:Day Shift
Description:
Responsible for all aspects of authorizations/pre-certification, or referral processes. Verifies insurance eligibility and contacts the payer to initiate pre-certification by providing supporting medical documentation, follow ups with insurance on outcome of determination for all medication, procedures, and services in attempt to obtain a successful authorization. Determines out of pockets costs for patients prior to treatment start and meet with patients to discuss and share findings, so patient is aware of financial responsibility. Assists in maintaining charge review and claim edit registration work queues and identifying trends to optimize workflows/education needed.
EducationMinimum: High school diploma or equivalent requiredPreferred: Degree preferred
Related ExperienceMinimum: 1-3 years of experience with insurance referrals, prior authorization or other equivalent knowledge or professional revenue cycle.Preferred: 3-5 years of experience with insurance referrals, prior authorization or other equivalent knowledge or professional revenue cycle, within an oncology setting.
Other Knowledge, Skills and Abilities•Knowledge of medical terminology and procedures at the level needed to perform responsibilities.•Proficient knowledge of major health plans and insurance processes.•Excellent communication skills in both written and verbal forms, including proper phone etiquette, including ability to effectively explain relevant insurance information to patients and providers as well as communicate with insurance plans and internal customers. Ability to read, understand and responds to detailed written and oral instructions.•Ability to work independently and collaboratively in a team-oriented environment; displays profession and friendly demeanor. Proficient knowledge of major health plans and insurance processes.
Computer CompetencyFamiliarity with standard desktop and Windows based computer system, including email, e-learning, intranet, and computer navigation. Experience working in electronic medical records, preferably EPIC. Ability to use other software required to perform essential functions.
Physical/MentalSitting for extended periods of time. Extensive computer work. Frequent standing, walking. Occasional bending stooping, twisting. Ability to hear speech, speak, use near-far vision and fine motor skills. Ability to perform continuously detailed tasks with frequent interruptions and work prioritization.
What Perks and Benefits Can You Look Forward to?Day-1 Benefits. Low cost benefits, including medical, dental, vision, 403B retirement and more.Paid holidays and generous Paid Time Off (PTO)
Up to 18 days of PTO your first year!
Day Shift Monday - Friday. No Holidays or WeekendsTuition reimbursementCareer Development ServicesCompetency based increases.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
Shift:Day Shift
Description:
Responsible for all aspects of authorizations/pre-certification, or referral processes. Verifies insurance eligibility and contacts the payer to initiate pre-certification by providing supporting medical documentation, follow ups with insurance on outcome of determination for all medication, procedures, and services in attempt to obtain a successful authorization. Determines out of pockets costs for patients prior to treatment start and meet with patients to discuss and share findings, so patient is aware of financial responsibility. Assists in maintaining charge review and claim edit registration work queues and identifying trends to optimize workflows/education needed.
EducationMinimum: High school diploma or equivalent requiredPreferred: Degree preferred
Related ExperienceMinimum: 1-3 years of experience with insurance referrals, prior authorization or other equivalent knowledge or professional revenue cycle.Preferred: 3-5 years of experience with insurance referrals, prior authorization or other equivalent knowledge or professional revenue cycle, within an oncology setting.
Other Knowledge, Skills and Abilities•Knowledge of medical terminology and procedures at the level needed to perform responsibilities.•Proficient knowledge of major health plans and insurance processes.•Excellent communication skills in both written and verbal forms, including proper phone etiquette, including ability to effectively explain relevant insurance information to patients and providers as well as communicate with insurance plans and internal customers. Ability to read, understand and responds to detailed written and oral instructions.•Ability to work independently and collaboratively in a team-oriented environment; displays profession and friendly demeanor. Proficient knowledge of major health plans and insurance processes.
Computer CompetencyFamiliarity with standard desktop and Windows based computer system, including email, e-learning, intranet, and computer navigation. Experience working in electronic medical records, preferably EPIC. Ability to use other software required to perform essential functions.
Physical/MentalSitting for extended periods of time. Extensive computer work. Frequent standing, walking. Occasional bending stooping, twisting. Ability to hear speech, speak, use near-far vision and fine motor skills. Ability to perform continuously detailed tasks with frequent interruptions and work prioritization.
What Perks and Benefits Can You Look Forward to?Day-1 Benefits. Low cost benefits, including medical, dental, vision, 403B retirement and more.Paid holidays and generous Paid Time Off (PTO)
Up to 18 days of PTO your first year!
Day Shift Monday - Friday. No Holidays or WeekendsTuition reimbursementCareer Development ServicesCompetency based increases.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.