Insurance Authorization Professional

$43,930 - $69,326/Yr

Monument Health Rapid City, SD - Rapid City, SD

Full-time - Entry Level

Rapid City, SD

About the position

The Insurance Authorization Professional at Monument Health plays a crucial role in facilitating patient access to medical services by managing pre-arrival prior authorization services. This position ensures that all scheduled medical service requests and referrals are financially cleared before the date of service, enhancing patient care through effective insurance eligibility validation and prior authorization processes.

Responsibilities

• Collaborate with healthcare providers, clinical staff, and various departments to secure necessary authorization for services while maintaining compliance with regulatory requirements.
• Accurately verify patient insurance eligibility and benefits coverage using Electronic Health Records (EHR) and other tools to ensure accurate reimbursement and compliance.
• Assess service requests to determine the need for pre-certification, pre-authorization, or referrals, and communicate effectively with stakeholders to secure approvals.
• Maintain knowledge of various insurance payers, payer plans, and program contract requirements to facilitate appropriate verification and authorization processes.
• Document pre-authorization information accurately in the EHR system to meet financial clearance criteria and prevent denial or penalty assessment.
• Engage with departments and clinical staff to communicate the need for pre-authorizations or referrals promptly, preventing delays in patient care.
• Identify high-risk requests that may require financial assistance and provide guidance on available resources and payment arrangements.
• Advocate for patients and providers by addressing challenges related to pre-authorization approvals and denials, working closely with leadership to resolve issues.
• Provide backup support for Patient Admissions and Registration as needed, while meeting competency requirements for role-specific functions.
• Create a positive service experience by being polite, compassionate, and professional with all customers.

Requirements

• High School Diploma/GED Equivalent in General Studies (Required)
• 1+ years in Health Care Services, Customer Service, Patient Scheduling, or Patient Billing Experience (Preferred)
• Associates degree in Healthcare Related Field (Preferred)
• Ability to exert up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly.

Nice-to-haves

• Experience in healthcare services or patient billing
• Associates degree in a healthcare-related field

Benefits

• Supportive work culture
• Medical, Vision and Dental Coverage
• Retirement Plans, Health Savings Account, and Flexible Spending Account
• Instant pay available for qualifying positions
• Paid Time Off Accrual Bank
• Opportunities for growth and advancement
• Tuition assistance/reimbursement
• Excellent pay differentials for evening, night, or weekend shifts
• Flexible scheduling