What are the responsibilities and job description for the Authorization Nurse position at IHA?
Partial remote opportunity once training is completed
Benefits include; Medical, Dental, Vision, Tuition Reimbursement, 403b Retirement Savings, PTO,
POSITION DESCRIPTION:
Responsible for reviewing, submitting, monitoring and responding to issues regarding prior authorization for high tech radiology services (MRI, CT, PET Scans, etc.) and upcoming procedures for IHA patients. Reviews patient medical history to identify supporting documentation in the patient chart relevant to the service or procedure; contacts insurance companies and obtains authorization for procedure or service. In specialty offices, obtains prior authorization for defined medications.
ESSENTIAL JOB FUNCTIONS:
- Responsible for reviewing, submitting, monitoring and responding to issues regarding prior authorizations for high tech radiology services (MRI, CT, PET Scans, etc.) and upcoming procedures for IHA patients. In specialty offices, this includes prior authorizations for defined medications.
- Communicates with ordering physician when radiology orders do not meet St. Joe’s MRI and CT guidelines.
- Under direction of a physician, orders radiology tests.
- Reviews patient medical history to identify supporting documentation in the patient chart relevant to the service or procedure.
- Contacts insurance companies and obtains authorization for procedure or service. In specialty offices, submits all prior authorizations and appropriate documentation required by specialty pharmacies and insurance companies for patients on defined medications. Ensures follow-up is conducted until approval is received and patient is notified.
- Acts as a resource for non-clinical staff.
- Updates information in patient medical record (EMR) with approval or declination information; follows up with Primary Care Physician as to status and/or issues with prior authorizations.
- Assists patients with Patient Assistance forms for patients with financial needs such as high copays or financial hardship.
- Supports other offices, attends required meetings and training and participates in committees as requested.
- Performs other duties as assigned and works within scope of RN/LPN licensure.
ESSENTIAL QUALIFICATIONS:
EDUCATION: Bachelor’s degree/graduate of an accredited Registered Nurse Program is preferred; may also have graduated from an accredited LPN Program.
CREDENTIALS/LICENSURE: Valid, unrestricted RN license in the State of Michigan or valid, unrestricted LPN license in the State of Michigan. Valid CPR certification.
MINIMUM EXPERIENCE: 1-2 years of clinical experience in a medical or physician office.
Job Type: Full-time
Pay: From $24.64 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Tuition reimbursement
- Vision insurance
- Work from home
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Supplemental Pay:
- Bonus pay
Education:
- High school or equivalent (Preferred)
Experience:
- Insurance verification: 1 year (Preferred)
- Medical billing: 1 year (Preferred)
Work Location: One location