This position is primarily responsible for ensuring that prior authorizations are effectively and courteously processed for patients receiving services in the Gerald L. Ignace Indian Health Center working directly with front office staff and providers.
ESSENTIALBEHAVIORS:
Build Trust:Operatewithtransparency, no hiddenagenda;placeconfidencein colleagues,givepropercreditto others.Followthrough on agreed upon actions.Treatsensitive or confidentialinformationappropriately.Keepemotionsundercontrol.Exhibitethicalandmoralbehaviorineverydaybusinessconduct. FosterCommunication:Demonstrateability to carefullylistento othersatalllevels of the organization. Seek and listentofeedbackand be approachable.Expressthoughtsandideaseffectively.Displayandpromotecrossculturalsensitivity. Display Stewardship:Understandbusinessimplications of decisions.Conserveorganizationresources.Lookforwaystoimproveandpromotequality.Takepersonal responsibility.Useresourcesinanefficientandcost-effectivemanner.
ESSENTIALDUTIES AND RESPONSIBILITIES:
Prior Authorization Specialists areresponsiblefordirect andindirectpatientcareactivities,includingbut not limited to:
Assist the Front Office staff with the daily pre-registration of patients scheduled for appointments. Proactively calls patients to inform them about any situation related to their medical insurance(s)
Performs data entry of insurance information.
Schedule and confirms medical appointments, reschedule, and cancel appointments if prior authorization is required and not in effect.
Review scheduled appointments, verify insurance, and determine the need for prior authorizations.
Work with providers to determine care plan and services to be provided under prior authorization.
Develop and maintain records of all submitted requests for prior authorizations.
Submit all services that require prior authorization to insurance carrier either online, phone or via fax.
Develop and maintain a method to track prior authorization services and dates to eliminate risk of providing service(s) that exceed the limits of the authorization.
Follow up on authorizations not received in a timely manner.
When authorizations are received, enter authorization information into EHR.
Monitor service(s) provided to be certain the billed service(s) matches the authorized service(s). Notify manager if there are discrepancies.
Determine need for additional authorization and submit requests for continuing services if necessary.
Complies with IHC, HIPAA and Privacy Rules.
Uses efficient and clear communication at all times.
Greets all patients in a friendly and professional manner including staff, vendors, providers, and community members.
Maintains and organizes filing systems and is knowledgeable in the operation of office equipment and software programs.
Asks for assistance if needed when directing incoming patients and visitors to the appropriate department or provider.
Attends and participates in all departmental meetings.
Maintains a current source of Front Office paperwork and forms. Keeps a clean, clutter free work area at all times.
Participates as a proactive representative of the Patient Centered Health Home.
Performs duties utilizing the Team-Based Approach.
Performs other duties as assigned.
QUALIFICATIONS(Educationand Training):
Requires a high school diploma or GED
Prefer prior experience working in a medical/clinical setting with at least one year working experience.
Experience processing prior authorizations.
Incumbent will be trained on the different Front Office areas: Reception, Eligibility, and Phone Operations.
Excellent customer service skills required
Excellent phone skills required
Previous knowledge of office practices and procedures in the behavioral health field preferred
Must be knowledgeable and proficient with medical terminology.
Ability to follow written and oral instructions
Flexibility, initiative, reliability, and creativity
Familiarity with medical computer software and data entry
Experience using Microsoft Office software packages (Word, Excel, and PowerPoint)
Experience working with Electronic Health Record systems, experience with EPIC is a plus.
Knowledge of & ability to work with the American Indian community & other minority populations
Ability to maintain strict confidentiality
Ability to function independently and as a team member within diverse environments as well as with a diverse staff composition
Demonstrated ability to perform multiple administrative functions simultaneously in an accurate, organized, & efficient manner. Ability to multitask & thrive in a fast-paced, constantly changing environment
Ability to carry out all responsibilities in an honest, ethical & professional manner and demonstrate good judgment
OTHERSIGNIFICANTFACTORS:
The physicalrequirementsdescribedherearerepresentative of those that must be met by anemployee to successfullyperformtheessentialfunctions of the job.Whileperformingtheduties of this job, the employeeisregularlyrequired to sit,stand,andwalk;usehands to manipulateobjects,tools or controls;reachwithhandsandarms;and talkandhear. The employeemustfrequentlylift and/or move up to 10 pounds and occasionallylift and/ormove up to25pounds.Specificvisionabilitiesrequired by this jobincludeclosevision,distancevision,peripheralvision, depth perceptionand the abilitytoadjustfocus. Noiselevelin the workenvironment is usuallyquiet.
Workisperformedinanofficeenvironment utilizingvarious office equipmentincluding,butnotlimited to, a computer,copymachine, fax machine,andmulti-linephone.Abilitytocommunicateeffectively over the telephone, by computerandinpersonis expected.Abilityto performwellin a fast-pacedworkenvironment,and to adjust to changesis expected.Reliabilityis highly valued.
This is a generaloutline of the essentialfunctions of this position andshallnot be construed asan all-inclusivedescription of allworkrequirementsandresponsibilities. The employee may be required to performotherjob-related duties asrequested by the designatedworkleader(s).Allrequirementsaresubjecttochange over time.Allpositions at theGeraldL.IgnaceIndianHealth Centerhave the responsibility to carryoutfunctions to maintaininspectionandsurveyreadiness,participateinQuality Improvementinitiatives,aswellasassistinand/orprovideeducationforhealthpromotionanddiseaseprevention.Reasonableaccommodation(s) may be madetoenableindividuals with disabilitiestoperform the essentialfunctions of this position.
GLIIHCsupports a safe,healthyanddrug-freeworkenvironment throughcriminalandcaregiverbackgroundchecksandpre-employment drugtesting.GLIIHCmaintains a smoke-freeenvironment. The Gerald L. Ignace Indian Health Center, Inc. provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disability. Equal Opportunity employer/Veteran/Disabled. American Indian and Veteran Preference employer.
Complete online application. If assistance or a different application format is needed contact resumes@gliihc.net or call Kaye Marty at (414) 316-5040.