Prior Authorization Specialist
Lifepoint Health
1 hour ago
Full-time
On-site
Hancock, Michigan, United States
Registered Nurse
Your experience matters
Up Health System- Portage part of Lifepoint Health
[https://lifepointhealth.net/locations], a diversified healthcare delivery
network with facilities coast to coast. We are driven by a profound commitment
to prioritize your well-being so you can provide exceptional care to others. By
joining our team, you're embracing a vital mission dedicated to making
communities healthier ®. Join us on this meaningful journey where your skills,
compassion and dedication will make a remarkable difference in the lives of
those we serve.
How you'll contribute
A Prior Authorization Specialist who excels in this role:
* Contacts insurance carriers to obtain benefit coverage, policy limitations,
authorization/notification, and pre-certifications for identified patients.
* Follows up with physician offices, financial counselors, patients, and
third-party payers to complete the pre-certification process.
* Collaborates with Supervisor, internal departments and clinical staff as
needed to provide account status updates, coordinate the resolution of
issues, and appeal denied authorizations.
* Ensures information obtained is complete and accurate, applying acquired
knowledge of Medicare, Medicaid, and third-party payer requirements/on-line
eligibility systems.
* Educates patients, staff and providers regarding referral and authorization
requirements, payer coverage, eligibility guidelines, documentation
requirements, and insurance related changes or trends.
* Ensures all services have prior authorizations and updates patients on their
preauthorization status. Coordinates peer to peer review if required by
insurance.
* Notifies patient accounts staff/patients of insurance coverage lapses, and
self-pay patient status.
* May notify ordering providers if authorization/certification is denied.
* May coordinate scheduling of patient appointments, diagnostic and/or
specialty appointments, tests and/or procedures.
* Maintains files for referral and insurance information and enters referrals
into the system.
* Maintains knowledge of and reference materials of the following: Medicare,
Medicaid and third-party payer requirements, guidelines and policies,
insurance plans requiring pre-authorization and a list of current accepted
insurance plans.
* Serves as an expert for peers across the patient access continuum.
* Meets daily productivity and quality standards associated with job
requirements.
Why join us
We believe that investing in our employees is the first step to providing
excellent patient care. In addition to your base compensation, this position
also offers:
* Comprehensive Benefits: Multiple levels of medical, dental and vision
coverage for full-time and part-time employees.
* Financial Protection & PTO: Life, accident, critical illness, hospital
indemnity insurance, short- and long-term disability, paid family leave and
paid time off.
* Financial & Career Growth: Higher education and certification tuition
assistance, loan assistance and 401(k) retirement package and company match.
* Employee Well-being: Mental, physical, and financial wellness programs (free
gym memberships, virtual care appointments, mental health services and
discount programs).
* Professional Development: Ongoing learning and career advancement
opportunities.
What we're looking for
Prior Authorization Specialist :
* Education: High School Diploma or Equivalent Required
* Requirements: Requires critical thinking skills, decisive judgment and the
ability to work with minimal supervision.
More about UP Health System – Portage
Your Regional Medical Center
UP Health System – Portage has been serving Michigan's Western Upper Peninsula
since 1896. It supports a multi-specialty medical community with over 40
physicians, and more than a dozen allied health professionals. The main campus
features a 36-bed hospital, accredited as a chest pain center by the Society of
Cardiovascular Patient Care (SCPC). UP Health System – Portage was the first in
the state to achieve Level III ACC (American College of Cardiology) verification
as a trauma center.
Additional services include dedicated physician hospitalists, cardiopulmonary
services, elective and emergency orthopedics, women’s health, general surgery,
hematology and oncology, internal medicine, sports medicine and rehabilitation
and sports medicine, x-ray and diagnostics (including MRI, mobile PET scan,
64-slice CT scanner, nuclear imaging, and 3D mammography), an advanced wound
care center, a sleep lab, two Express Care walk-in clinics, a regional dialysis
unit, pharmacy services, laboratory services, home care, and a 60-bed senior
living community.
UP Health System- Portage
Our Community
With small communities and big ideas, Michigan's Upper Peninsula is the perfect
place for people to explore their many interests. Visit the art galleries, and
museums, walk along the beaches of Lake Superior, hike, bike, and explore the
beautiful nature trails. Wrap yourself up in a blanket of bright stars, clean
air and open water.
Hancock is a community that brings together small-town values, rich history and
a four-season wonderland for outdoor enthusiasts — without long commute times or
congested highways. The Keweenaw is home to two universities — Michigan
Technological University and Finlandia University. The community benefits from
the diversity, culture and high standards of living contributed to our small
town. We often call the Keweenaw the "Copper Country" because of the amount of
natural "float" copper found in the area. In fact, at 90% pure, much of the
copper is the purest copper in the world.
Welcome, to the Keweenaw Peninsula!
EEOC Statement
UP Health- Portage is an Equal Opportunity Employer. Marquette General
Hospital is committed to Equal Employment Opportunity for all applicants and
employees and complies with all applicable laws prohibiting discrimination and
harassment in employment."
Lifepoint Health is a leader in community-based care and driven by a mission of
Making Communities Healthier. Our diversified healthcare delivery network spans
29 states and includes 63 community hospital campuses, 32 rehabilitation and
behavioral health hospitals, and more than 170 additional sites of care across
the healthcare continuum, such as acute rehabilitation units, outpatient centers
and post-acute care facilities. We believe that success is achieved through
talented people. We want to create places where employees want to work, with
opportunities to pursue meaningful and satisfying careers that truly make a
difference in communities across the country.
We employ and provide care to people from all walks of life. We are committed to
promoting healing, providing hope, preserving dignity and producing value with
an inclusive workforce in which diversity is leveraged, respected, and
reflective of the patients, family members, customers and team members we serve.
Up Health System- Portage part of Lifepoint Health
[https://lifepointhealth.net/locations], a diversified healthcare delivery
network with facilities coast to coast. We are driven by a profound commitment
to prioritize your well-being so you can provide exceptional care to others. By
joining our team, you're embracing a vital mission dedicated to making
communities healthier ®. Join us on this meaningful journey where your skills,
compassion and dedication will make a remarkable difference in the lives of
those we serve.
How you'll contribute
A Prior Authorization Specialist who excels in this role:
* Contacts insurance carriers to obtain benefit coverage, policy limitations,
authorization/notification, and pre-certifications for identified patients.
* Follows up with physician offices, financial counselors, patients, and
third-party payers to complete the pre-certification process.
* Collaborates with Supervisor, internal departments and clinical staff as
needed to provide account status updates, coordinate the resolution of
issues, and appeal denied authorizations.
* Ensures information obtained is complete and accurate, applying acquired
knowledge of Medicare, Medicaid, and third-party payer requirements/on-line
eligibility systems.
* Educates patients, staff and providers regarding referral and authorization
requirements, payer coverage, eligibility guidelines, documentation
requirements, and insurance related changes or trends.
* Ensures all services have prior authorizations and updates patients on their
preauthorization status. Coordinates peer to peer review if required by
insurance.
* Notifies patient accounts staff/patients of insurance coverage lapses, and
self-pay patient status.
* May notify ordering providers if authorization/certification is denied.
* May coordinate scheduling of patient appointments, diagnostic and/or
specialty appointments, tests and/or procedures.
* Maintains files for referral and insurance information and enters referrals
into the system.
* Maintains knowledge of and reference materials of the following: Medicare,
Medicaid and third-party payer requirements, guidelines and policies,
insurance plans requiring pre-authorization and a list of current accepted
insurance plans.
* Serves as an expert for peers across the patient access continuum.
* Meets daily productivity and quality standards associated with job
requirements.
Why join us
We believe that investing in our employees is the first step to providing
excellent patient care. In addition to your base compensation, this position
also offers:
* Comprehensive Benefits: Multiple levels of medical, dental and vision
coverage for full-time and part-time employees.
* Financial Protection & PTO: Life, accident, critical illness, hospital
indemnity insurance, short- and long-term disability, paid family leave and
paid time off.
* Financial & Career Growth: Higher education and certification tuition
assistance, loan assistance and 401(k) retirement package and company match.
* Employee Well-being: Mental, physical, and financial wellness programs (free
gym memberships, virtual care appointments, mental health services and
discount programs).
* Professional Development: Ongoing learning and career advancement
opportunities.
What we're looking for
Prior Authorization Specialist :
* Education: High School Diploma or Equivalent Required
* Requirements: Requires critical thinking skills, decisive judgment and the
ability to work with minimal supervision.
More about UP Health System – Portage
Your Regional Medical Center
UP Health System – Portage has been serving Michigan's Western Upper Peninsula
since 1896. It supports a multi-specialty medical community with over 40
physicians, and more than a dozen allied health professionals. The main campus
features a 36-bed hospital, accredited as a chest pain center by the Society of
Cardiovascular Patient Care (SCPC). UP Health System – Portage was the first in
the state to achieve Level III ACC (American College of Cardiology) verification
as a trauma center.
Additional services include dedicated physician hospitalists, cardiopulmonary
services, elective and emergency orthopedics, women’s health, general surgery,
hematology and oncology, internal medicine, sports medicine and rehabilitation
and sports medicine, x-ray and diagnostics (including MRI, mobile PET scan,
64-slice CT scanner, nuclear imaging, and 3D mammography), an advanced wound
care center, a sleep lab, two Express Care walk-in clinics, a regional dialysis
unit, pharmacy services, laboratory services, home care, and a 60-bed senior
living community.
UP Health System- Portage
Our Community
With small communities and big ideas, Michigan's Upper Peninsula is the perfect
place for people to explore their many interests. Visit the art galleries, and
museums, walk along the beaches of Lake Superior, hike, bike, and explore the
beautiful nature trails. Wrap yourself up in a blanket of bright stars, clean
air and open water.
Hancock is a community that brings together small-town values, rich history and
a four-season wonderland for outdoor enthusiasts — without long commute times or
congested highways. The Keweenaw is home to two universities — Michigan
Technological University and Finlandia University. The community benefits from
the diversity, culture and high standards of living contributed to our small
town. We often call the Keweenaw the "Copper Country" because of the amount of
natural "float" copper found in the area. In fact, at 90% pure, much of the
copper is the purest copper in the world.
Welcome, to the Keweenaw Peninsula!
EEOC Statement
UP Health- Portage is an Equal Opportunity Employer. Marquette General
Hospital is committed to Equal Employment Opportunity for all applicants and
employees and complies with all applicable laws prohibiting discrimination and
harassment in employment."
Lifepoint Health is a leader in community-based care and driven by a mission of
Making Communities Healthier. Our diversified healthcare delivery network spans
29 states and includes 63 community hospital campuses, 32 rehabilitation and
behavioral health hospitals, and more than 170 additional sites of care across
the healthcare continuum, such as acute rehabilitation units, outpatient centers
and post-acute care facilities. We believe that success is achieved through
talented people. We want to create places where employees want to work, with
opportunities to pursue meaningful and satisfying careers that truly make a
difference in communities across the country.
We employ and provide care to people from all walks of life. We are committed to
promoting healing, providing hope, preserving dignity and producing value with
an inclusive workforce in which diversity is leveraged, respected, and
reflective of the patients, family members, customers and team members we serve.