Prior Authorization Specialist

Your Experience Matters

Up Health System
- Portage part of Lifepoint Health, 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.

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.

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.

• Education:
  
  High School Diploma or Equivalent Required
• Requirements:
  Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

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…