Prior Authorization Specialist

# Prior Authorization Specialist Cozad Community Hospital - Cozad, NE 69130## Overview Salary Range $18.75 - $31.25 Hourly Level Entry Position  Type Full Time## Description
** Our Mission:
** To improve the health and well-being of the communities we serve demonstrating compassionate, patient-centered care.

Summary The Prior Authorization Specialist is responsible for obtaining prior authorization for all outpatient and inpatient services. This position will also monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services and monitor the appropriateness of hospital admissions and extended hospitals stays in accordance with the philosophy, goals, and objectives of Cozad Community Health System.
** Essential Duties and Responsibilities
** This description intends to describe the general nature and level of work performed by employees assigned to this job. It is not intended to include all duties, responsibilities, and qualifications. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
** Prior Authorization duties:
*** Responds to all correspondence from providers and patients with regard to prior authorization.
* Submits authorization requests via insurance portals or via phone calls. Checks on pending requests regularly to ensure patients obtain their services in a timely manner.
* Reviews demographic and insurance information in patient accounts and notifies Business Office when information needs corrected.
* Contacts provider staff when pre-certification is needed for services and confirms pre-certifications have been obtained.
* Researches and maintains current rules, and regulations for insurance payers by utilizing all resources.

Utilization Review duties:
* Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions are occurring.
* Coordinates, troubleshoots, and resolves identified utilization review problems timely by conducting real time UR meetings.
* Works with the Billing Department to support resolving patient denials based upon appropriate patient status.
* Performs concurrent reviews for patients to ensure that extended stays are medically justified and are also documented in patient's medical records.
* Contacts providers when pre-certification is needed and confirms pre-certifications have been obtained.

General duties:
* Develops and maintains positive working relationships with patients, co-workers, vendors, third-party payor resources, and related entities.
* Researches and maintains current laws, rules, and regulations with billing charges by utilizing all resources.
* Stays current on all Medicare issues, Program Memorandums, Med-Learn matters articles, Change Requests, CPT/HCPCS codes, and other regulatory documents.
* Provides quality healthcare services to all patients.
* Follows all HIPAA guidelines and promotes and ensures patient safety.
* Fulfills mission statement by performing job duties with a high level of customer service while contributing to a positive and professional environment.
* Special projects and other duties assigned.## Qualifications
** Supervisory Responsibilities
** No supervisory responsibilities.
** Qualifications
* * To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
** Education and/or Experience
** High…