Prior Authorization Representative

Employment Type: Full time Shift: Day Shift Description: Samaritan Hospital Full Time Authorization Clinician Position Summary : The Authorization C linician for outpatient is responsible for the tracking and review of those cases requiring telephonic case management. Tracking is accomplished via computer. Pre-authorization and case management is done with reviewers at the Managed Care Organization that is responsible for approving a client's treatment. The Authorization Clinician for inpatient is responsible for managing the authorization process for prospective patients and insurers . This involves determining an appropriate level of care based on established admission criteria ; once those determinations are made, presenting the clinical cases to insurers and managed care companies to secure authorizations for admission to treatment at the S t. Peters inpatient rehabs . Also responsible for : welcoming and registering incoming patients to rehab, screening prospective clients for placement into the numerous St. Peter's addictions programs & investigat ing delinquent accounts and secur ing payment for denials ; The Authorization Clinician is i nstrumental in answering inquiries from referents and persons in the community seeking treatment for substance abuse , providing guidance to appropriate levels of care in the SPARC continuum or other agencies in the community. Education Requirements : Bachelor’s degree or Associates degree with a QHP is required. M aster ' s degree in a related field and QHP is preferred. Experience Requirements : One to three years experience in the Behavioral Services field a prerequisite. Experience with insurance/managed care organizations a plus. Familiarity with PC basics necessary with the ability to learn new programs . Strong writing and communication skills are required, as well as knowledge of working with community agencies and managed care representatives. E xperience working with a diverse population and a strong understanding of multicultural issues is preferred Pay range: $24.60-$35.70 Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. #J-18808-Ljbffr