Prior Authorization Specialist - Northwestern Medical Center

Prior Authorization Specialist

Patient Access Department

Join our award-winning team!

Northwestern Medical Center, where you can be the difference!

Looking to advance your career at a vibrant, community hospital in a locale that will have you wondering why you ever chose to live anywhere else? Come join the Northwestern Medical Center family, where our focus on high reliability ensures 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, all while enjoying the quality of life Vermont provides.

Northwestern Medical Center's mission is to provide exceptional healthcare for our community and we are currently recruiting for a Full-time Prior Authorization Specialist opportunity.

EXPECTED HOURS/SHIFT: Full-Time (80 hours bi-weekly), generally Monday-Friday, 8:00a-4:30p

• 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.

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

PI239976806