[Remote] Prior Authorization Specialist, Hopedale IL Location, not a remote position

Note: The job is a remote job and is open to candidates in USA. Hopedale Medical Complex is seeking a Prior Authorization Specialist to ensure reimbursement for scheduled services in line with payer-provider contracts. The specialist will contact payers for service authorizations, determine insurance coverage for tests/procedures, and provide financial counseling to patients. Responsibilities Verifies patient’s insurance and benefits information Obtains prior authorizations from third-party payers in accordance with payer requirements Works with other departments to gather the clinical information required by the payer to authorize services Maintains accurate records of authorizations within the EMR Works with the business office to support appeal efforts for authorization related denials Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality Maintains professional tone at all times when communicating with patients and payer representatives Completes approved adjustments as requested and adds charges as requested Keep filing updated for easy access Keep the waiting area orderly throughout the day Assist in maintaining accurate patient business records Orders and maintains supplies as required Maintains good working relationship both within the department and with other departments Demonstrates an ability to be flexible, organized and function well in a stressful situation Treat patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information Follows established departmental policies, procedures, and objectives. Continues quality improvement objectives and safety, environmental and/or infection control standards Other duties as assigned by the Patient Access Manager Skills Ensures that payers are prepared to reimburse Hopedale Medical Complex for scheduled services in accordance with the payer-provider contract Contacts payers to request service authorizations Collects financial and/or demographic information from patients as needed Determines insurance coverage for tests/procedures and counsels patients regarding this coverage Performs financial counseling duties Verifies patient's insurance and benefits information Obtains prior authorizations from third-party payers in accordance with payer requirements Works with other departments to gather the clinical information required by the payer to authorize services Maintains accurate records of authorizations within the EMR Works with the business office to support appeal efforts for authorization related denials Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality Maintains professional tone at all times when communicating with patients and payer representatives Completes approved adjustments as requested and adds charges as requested Keeps filing updated for easy access Keeps the waiting area orderly throughout the day Assists in maintaining accurate patient business records Orders and maintains supplies as required Maintains good working relationship both within the department and with other departments Demonstrates an ability to be flexible, organized and function well in a stressful situation Treats patients and their families with respect and dignity; ensures confidentiality of patients personal and medical information Follows established departmental policies, procedures, and objectives Continues quality improvement objectives and safety, environmental and/or infection control standards Other duties as assigned by the Patient Access Manager Benefits Tuition Reimbursement Excellent benefits - health, dental, vision, and life and disability insurance Quality childcare located on site HMC Wellness Center membership 401(k) plan with employer match Employee Daycare Rates Company Overview Hopedale Medical Complex is a non-profit organization that offers independent living facilities and professional health & medical services. It was founded in 1955, and is headquartered in Hopedale, Illinois, USA, with a workforce of 201-500 employees. Its website is Company H1B Sponsorship Hopedale Medical Complex has a track record of offering H1B sponsorships, with 3 in 2022. Please note that this does not guarantee sponsorship for this specific role.