Prior Authorization Specialist - Northwestern Medical Center

Prior Authorization Specialist

Central Registration

Northwestern Medical Center, where you can be the difference.

Come join the NMC family, where we focus on high reliability, ensuring a constant emphasis on safety, quality, and improvement as we pursue our mission of exceptional care. Be part of a team where you can make a difference. NMC's mission is to provide exceptional healthcare for our community.

NMC is currently recruiting for a Prior Authorization Specialist in Central Registration.This position is a full-time (80 hours bi-weekly) position, hours vary between 7 a.m. and 6 p.m.

JOB SUMMARY:

The Prior Authorization Specialist performs payer eligibility, complex financial clearance, and pre-certification and prior authorization functions for the organization. The Specialist obtains pre-certification and prior authorizations directly from insurance payers for ambulatory, outpatient, and inpatient services. The Specialist will validate authorizations for scheduled services. The Specialist acts as the organizational subject matter expert for prior authorization and pre-certification payer requirements and processing, and will collaborate with internal and external stakeholders to provide knowledge, guidance, and training. The Specialist will research and monitor payer correspondence to stay updated on specific payer rules and requirements. The Specialist will log and action any denials related to prior authorization and may assist with obtaining retroactive authorizations, facilitating appeals, and providing interventions to prevent future denials from occurring. The Specialist may perform functions of a Pre-Encounter Representative as needed to include scheduling and pre-registration.

PREREQUISITES

Education: High school graduate or equivalent. Associates degree preferred.

Experience: Prior customer service experience preferred. Prior administrative/clerical experience in medical office/hospital setting preferred. Prior clerical work experience in a medical office, knowledge of medical terminology, proficient typing skills preferred.

Skills: Basic computer and typing skills required. Must be detail oriented, organized, be able to handle multiple tasks and responsibilities and prioritize appropriately, have basic math skills to collect money and make change, and have strong communication skills to communicate with people in a professional and tactful manner.

Northwestern Medical Center’s Benefit Package:

With “people” as one of our core values, valuing our employees is a top priority for Northwestern Medical Center. We care about our employees, their families, and their overall health & well-being. We are proud to offer a comprehensive & generous benefits package designed to help our people stay healthy, balance work & life responsibilities, protect their assets & plan for a secure financial future. Northwestern offers a comprehensive benefit package with recognized national carriers as well tuition assistance programs.

Apply online at: https://www.northwesternmedicalcenter.org/careers/open-positions/all-open-positions/

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PI255275609