Prior Authorization Specialist RN PRN - Intermountain Health
Columbia, SC
About the Job
Job Description:
The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity, payer policies, appeals and reconsideration needs. Promotes the quality and cost effectiveness of patient care using clinical acumen in preparation of documentation, audits of patient records, while offering clinical expertise and support to non-clinical caregivers and leaders unique to the department's needs.
This is a PRN position "As needed to cover PTO/Leave and high volume workloads"
ESSENTIAL DUTIES AND RESPONSIBILITIES
+ Utilize nursing experience and clinical acumen to verify, prepare and compile necessary clinical documentation required and initiate prior authorization, pre-determination and/or dispute denials via retro authorization, appeals or reconsiderations related to no authorization denials
+ Perform clinical reviews and submission of complex authorization requests using appropriate criteria, medical policy review and department expectations
+ Collaborate with various caregivers within or outside department, provider networks and clinical care site partners and care team to coordinate patient care and financial health
+ Equip and support authorization caregivers with needed resources and supplemental documentation to perform their duties
+ Participates in individual or group continued education opportunities and new tool/resource learning and workflow development projects
+ Professionally collaborate with caregivers, physicians, medical assistants, nurses, and other staff members to ensure patient needs are met and to financially secure patients encounter(s)
+ Explains and answers patient, caregiver, provider, or clinical team questions when able
+ Denial review, appeal, and reconsideration submission for multi-service line encounters
+ Peer training support and mentoring
+ Promotes mission, vision and values of Intermountain Health and abides by service behavior standards
Education:
Required:
+ Associates Degree in Nursing
Preferred:
+ Bachelor's Degree in Nursing
CERTIFICATION, REGISTRATION, LICENSE
(*indicates primary source verification requirement)
Required:
+ Active Registered Nurse License
Preferred:
+ Certified Healthcare Access Associate (CHAA)
EXPERIENCE
Required:
+ Licensed Registered Nurse
+ Minimum of 2 years’ experience in acute clinical nursing setting
+ Knowledge of utilization management and case management principles preferred
KNOWLEDGE, SKILLS, AND ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
+ Ability to work with technical accuracy and in a remote atmosphere
+ Demonstrated ability to multitask between computer and multi-communication applications (phone, email, fax, chat etc.)
+ Efficiently navigate EMR system actions as well clinical applications unique to the RN role where caregivers do not have access or expertise
+ General knowledge of patient access workflows for patient demographics, registration, insurance plans and benefits and billing practices
+ Demonstrates excellent customer service and communication skills and the highest ethical standards in both verbal and written form
+ Strong interpersonal, negotiation, conflict management skills, exceptional phone etiquette and communication skills are required
+ Self-starter with the ability to work independently and multitask to meet required deadlines and the ability to manage and prioritize workload in high volume environment
+ Ability to act as a clinical resource to non-clinical team members as necessary
+ Proficient in use of CPT, ICD-10 codes and medical terminology
+ Detail oriented with above average organizational and time management skills
+ Skilled in using and navigating web-based tools, insurance portals, bolt on tools and computer literate with the flexibility to learn new software programs
+ Exhibits ability to manage multiple priorities and prioritize workload to meet or exceed departmental performance expectations such as quality, productivity, and due diligence
+ Can proficiently complete and create all role specific competencies
+ Ability to diffuse and de-escalate frustrating and intense situations
+ Perform in depth clinical research on patient authorization issues and/or payment denials related to no authorization
+ General coding, billing, and claims processing knowledge
Physical Requirements:
Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.- and -Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.- and -Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc.- and -Expected to lift and utilize full range of movement to transfer patients. Will also bend to retrieve, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.- and -Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items. Often required to navigate crowded and busy rooms (full of equipment, power cords on the floor, etc).- and -May be expected to stand in a stationary position for an extended period of time.
Location:
Peaks Regional Office
Work City:
Broomfield
Work State:
Colorado
Scheduled Weekly Hours:
0
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$39.99 - $59.18
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity, payer policies, appeals and reconsideration needs. Promotes the quality and cost effectiveness of patient care using clinical acumen in preparation of documentation, audits of patient records, while offering clinical expertise and support to non-clinical caregivers and leaders unique to the department's needs.
This is a PRN position "As needed to cover PTO/Leave and high volume workloads"
ESSENTIAL DUTIES AND RESPONSIBILITIES
+ Utilize nursing experience and clinical acumen to verify, prepare and compile necessary clinical documentation required and initiate prior authorization, pre-determination and/or dispute denials via retro authorization, appeals or reconsiderations related to no authorization denials
+ Perform clinical reviews and submission of complex authorization requests using appropriate criteria, medical policy review and department expectations
+ Collaborate with various caregivers within or outside department, provider networks and clinical care site partners and care team to coordinate patient care and financial health
+ Equip and support authorization caregivers with needed resources and supplemental documentation to perform their duties
+ Participates in individual or group continued education opportunities and new tool/resource learning and workflow development projects
+ Professionally collaborate with caregivers, physicians, medical assistants, nurses, and other staff members to ensure patient needs are met and to financially secure patients encounter(s)
+ Explains and answers patient, caregiver, provider, or clinical team questions when able
+ Denial review, appeal, and reconsideration submission for multi-service line encounters
+ Peer training support and mentoring
+ Promotes mission, vision and values of Intermountain Health and abides by service behavior standards
Education:
Required:
+ Associates Degree in Nursing
Preferred:
+ Bachelor's Degree in Nursing
CERTIFICATION, REGISTRATION, LICENSE
(*indicates primary source verification requirement)
Required:
+ Active Registered Nurse License
Preferred:
+ Certified Healthcare Access Associate (CHAA)
EXPERIENCE
Required:
+ Licensed Registered Nurse
+ Minimum of 2 years’ experience in acute clinical nursing setting
+ Knowledge of utilization management and case management principles preferred
KNOWLEDGE, SKILLS, AND ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
+ Ability to work with technical accuracy and in a remote atmosphere
+ Demonstrated ability to multitask between computer and multi-communication applications (phone, email, fax, chat etc.)
+ Efficiently navigate EMR system actions as well clinical applications unique to the RN role where caregivers do not have access or expertise
+ General knowledge of patient access workflows for patient demographics, registration, insurance plans and benefits and billing practices
+ Demonstrates excellent customer service and communication skills and the highest ethical standards in both verbal and written form
+ Strong interpersonal, negotiation, conflict management skills, exceptional phone etiquette and communication skills are required
+ Self-starter with the ability to work independently and multitask to meet required deadlines and the ability to manage and prioritize workload in high volume environment
+ Ability to act as a clinical resource to non-clinical team members as necessary
+ Proficient in use of CPT, ICD-10 codes and medical terminology
+ Detail oriented with above average organizational and time management skills
+ Skilled in using and navigating web-based tools, insurance portals, bolt on tools and computer literate with the flexibility to learn new software programs
+ Exhibits ability to manage multiple priorities and prioritize workload to meet or exceed departmental performance expectations such as quality, productivity, and due diligence
+ Can proficiently complete and create all role specific competencies
+ Ability to diffuse and de-escalate frustrating and intense situations
+ Perform in depth clinical research on patient authorization issues and/or payment denials related to no authorization
+ General coding, billing, and claims processing knowledge
Physical Requirements:
Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.- and -Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.- and -Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc.- and -Expected to lift and utilize full range of movement to transfer patients. Will also bend to retrieve, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.- and -Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items. Often required to navigate crowded and busy rooms (full of equipment, power cords on the floor, etc).- and -May be expected to stand in a stationary position for an extended period of time.
Location:
Peaks Regional Office
Work City:
Broomfield
Work State:
Colorado
Scheduled Weekly Hours:
0
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$39.99 - $59.18
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
Source : Intermountain Health