Prior Authorization Generalist

Posted Date: 7/7/2023

Job Location: St. Anthony Regional Hospital, 311 South Clark St, PO Box 628, Carroll, IA, 51401
Department: Prior Authorization
Employment Type: Full-Time

Job Description

Job Summary

Completes prior authorizations in a centralized department for surgical procedures, medications and treatments, radiologic imaging, and outpatient treatments, in accordance with insurance payer requirements and hospital policies and procedures, in order to facilitate quality and timely services to patients.

Essential Duties and Responsibilities

• Ensures proper insurance information is obtained

• Works with clinical team on ensuring insurance payers have appropriate clinical documentation needed to process prior authorizations in a timely manner

• Relays patient information to insurance companies for certification and authorization of procedures, medications, treatments, imaging, and rehabilitation services.

• Ensures proper documentation of authorization processes, approvals, denials, effective dates, and end dates in the electronic medical record

• Reviews orders for medical necessity purposes.

• Works willingly and accepts assignments as given.

• Attends all mandatory meetings and programs.

• Participates in opportunities that enhance personal and professional growth.

• Performs other duties as necessary or assigned.

• Complies with the Corporate Compliance Policy and all laws, regulations, and Standards of Conduct relating to the position and agrees to report any suspected violations of law or Standards of Conduct.

• Complies with all applicable state and federal regulations.

• Maintains a safe work environment using safe work practices, utilizing standard precautions and complying with hazardous waste procedures at all times as described in St. Anthony's Safety Manual.

• Maintains the confidentiality of patient, resident, employee and organizational information.

• Other duties as assigned.

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

• Previous work experience in a healthcare setting preferred.

• Excellent verbal and written communication skills.

• Proficient in computer systems and Microsoft Office products.

Language Skills

Ability to read and interpret documents such as financial reports, insurance documents, safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before customers, patients, families and employees of the organization. Ability to read, analyze, and interpret healthcare regulations.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand; talk and hear; and use hands to finger, handle or feel. The employee is frequently required to stoop, kneel, crouch, or crawl and reach with hands and arms. The employee is frequently required to walk and sit. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 21 pounds, and occasionally lift and/or move up to 35 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, color vision, depth perception, and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

If you have further questions, please call the Human Resources Department at 712-794-5111.