Prior Authorization Specialist

Job Description

Your experience matters

Up Health System- Portage part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. By joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

How you'll contribute

A Prior Authorization Specialist who excels in this role:

• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for identified patients.
• Follows up with physician offices, financial counselors, patients, and third-party payers to complete the pre-certification process.
• Collaborates with Supervisor, internal departments and clinical staff as needed to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
• Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.
• Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
• Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status.
• May notify ordering providers if authorization/certification is denied.
• May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
• Maintains files for referral and insurance information and enters referrals into the system.
• Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
• Serves as an expert for peers across the patient access continuum.
• Meets daily productivity and quality standards associated with job requirements.

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

What we're looking for

Prior Authorization Specialist:

• Education: High School Diploma or Equivalent Required

• Requirements: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

More about UP Health System Portage

Your Regional Medical Center

UP Health System Portage has been serving Michigan's Western Upper Peninsula since 1896. It supports a multi-specialty medical community with over 40 physicians, and more than a dozen allied health professionals. The main campus features a 36-bed hospital, accredited as a chest pain center by the Society of Cardiovascular Patient Care (SCPC). UP Health System Portage was the first in the state to achieve Level III ACC (American College of Cardiology) verification as a trauma center.

Additional services include dedicated physician hospitalists, cardiopulmonary services, elective and emergency orthopedics, women's health, general surgery, hematology and oncology, internal medicine, sports medicine and rehabilitation and sports medicine, x-ray and diagnostics (including MRI, mobile PET scan, 64-slice CT scanner, nuclear imaging, and 3D mammography), an advanced wound care center, a sleep lab, two Express Care walk-in clinics, a regional dialysis unit, pharmacy services, laboratory services, home care, and a 60-bed senior living community.

UP Health System- Portage Our Community

With small communities and big ideas, Michigan's Upper Peninsula is the perfect place for people to explore their many interests. Visit the art galleries, and museums, walk along the beaches of Lake Superior, hike, bike, and explore the beautiful nature trails. Wrap yourself up in a blanket of bright stars, clean air and open water.

Hancock is a community that brings together small-town values, rich history and a four-season wonderland for outdoor enthusiasts without long commute times or congested highways. The Keweenaw is home to two universities Michigan Technological University and Finlandia University. The community benefits from the diversity, culture and high standards of living contributed to our small town. We often call the Keweenaw the "Copper Country" because of the amount of natural "float" copper found in the area. In fact, at 90% pure, much of the copper is the purest copper in the world.

Welcome, to the Keweenaw Peninsula!

EEOC Statement

UP Health- Portage is an Equal Opportunity Employer. Marquette General Hospital is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.