Sr Prior Authorization Spclst

Sr Prior Authorization Specialist

Children's Minnesota is one of the largest pediatric health systems in the United States and the only health system in Minnesota to provide care exclusively to children, from before birth through young adulthood. An independent and not-for-profit system since 1924, Children's Minnesota is one system serving kids throughout the Upper Midwest at two free-standing hospitals, nine primary care clinics, multiple specialty clinics and seven rehabilitation sites. As The Kids Experts in our region, Children's Minnesota is regularly ranked by U.S. News & World Report as a top children's hospital.

The Patient Registration and Insurance Verification department is involved in gathering demographic and insurance information for inpatients, outpatients, surgical patients and Emergency Department patients.

The Sr Prior Authorization Specialist promotes an excellent patient experience by ensuring authorizations are in place for services performed at Children's Minnesota prior to their admission to our facilities to secure payment and reduce the out of pocket costs to our patients and families.

This position is responsible for all duties associated with prior authorizations including reviewing insurance benefits, understanding third party requirements, securing authorizations for services, appealing pre-service authorization denials, and appealing authorization related claim denials.

Location: Remote within MN & WI

License/Certification/Registration required? No

Education:

• High School Diploma or GED
• Post-secondary education in a related field preferred.

Experience:

• Three years' experience in a healthcare or related field.
• Preferred experience: Three years' experience in medical billing/prior authorization/insurance.

Knowledge/Skills/Abilities:

• Knowledge in governmental and commercial payors, medical billing requirements, and prior authorizations.
• Demonstrated knowledge of Prior Authorization operations and medical office and/or hospital procedures.
• Ability to interpret and cascade payor requirements as they relate to insurance prior authorizations.
• Ability to effectively work in both a team environment and independently.
• Ability to establish and maintain effective working relationships with providers, patients, families, and employees.
• Ability to effectively work in a remote environment and connect via multiple communication channels (phone, email, text, etc.).
• Knowledge of how prior authorization functions impact billing, clinical teams, the quality of care and the patient experience.
• Ability to meet and exceed departmental quality, production and prior authorization standards.
• Ability to review and resolve denials pertaining to Prior Authorizations.
• Ability to suggest workflows that improve efficiency and experience.
• Ability to mentor and motivate a remote team that delivers exceptional customer service via multiple communication channels (phone, email, text, etc.).
• Skill in Microsoft Office.
• Skill in written and oral communication.

All job offers are contingent upon successful completion of an occupational health assessment, drug screen, background investigation, and compliance with the U.S. Government Form I-9, Employment Eligibility Verification. Children's Minnesota requires proof of COVID-19 vaccine, and as recommended by the Centers for Disease Control and Prevention (CDC), immunity to vaccine preventable infectious diseases, prior to employment.

Children's Minnesota is committed to providing Equal Employment Opportunities to all applicants. EO M/F/Disability/Vet Employer.