1+ months
2018-06-122018-09-09

Prior Authorization Specialist

Virginia Mason Medical Center
Seattle, WA

Job Number: 181477\n

Department: Authorization\n

Hours: 8:00 am - 4:30 pm\n

Located in Seattle, WA, Virginia Mason is an internationally recognized leader in the continuous improvement of health care. With an extensive list of awards and distinctions that includes our recognition as a Leapfrog Top Hospital of the Decade; Virginia Mason offers you the opportunity to partner with exceptionally talented peers at every level.  \n

You will contribute to the strength of our Team Medicine approach to collaborative medicine and benefit from the changes enacted through our Virginia Mason Production System, a model that has transformed health care by providing patients with easier access to care, reducing errors, and continuously innovating patient safety and quality that has been adopted by other organizations here and abroad. Join us, and find out how many ways Virginia Mason offers you the chance to focus on what really matters… your patients. \n
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This position is responsible for ensuring timely authorization from insurance carriers to optimize VMMC revenue cash flow. This position will maintain a working knowledge of our financial system and knowledge of insurance requirements. This position will obtain authorization for both professional and facility services as well as notification for inpatient stays. This position will handle pre-certification requests for the multi practices including surgery within Virginia Mason Medical Center. This position collects, reviews, discusses, and documents demographic, insurance, and financial information with patients and payers. Responsible for management and collection of Account Receivables through the use of automated systems and revenue cycle processes. Responds to and resolves a variety of account, billing and payment issues from patients and customers. Follow approved guidelines and policies regarding routine patient and payer interactions. Makes independent decisions that require individual and/or team analysis, reasoning, and problem solving. Interprets, applies and communicates Virginia Mason policies regarding medical and financial aspects of patient care to assure optimal reimbursement for both patient and Virginia Mason. Accurately documents interactions and interpret interactions documented by others.
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Responsibilities include:\n
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  • Work with multiple systems such as GE, Cerner, Image Cast, Mosaiq, auth tool and payer websites \n
  • Call/navigate insurance websites for authorization requirements and obtain timely authorizations from various insurance companies \n
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    Communicate with insurance carriers, both internal and external customers and patients via phone or written correspondence. \n
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    Follow up on insurance determination and contact Provider sections and patients if services are denied by insurance \n
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    Submit urgent add-ons (Last minute CPT code submissions to insurance) \n
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    Trend reporting to supervisor to assure accurate capture of services needing authorization \n
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    Verify insurance eligibility and benefits \n
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    Responsible for selecting accurate medical records for patient safety and obtaining and validating demographic and insurance information. \n
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    Responsible for providing all required medical information to insurance companies as necessary to facilitate the authorization process. \n
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    File appeals as necessary\n

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    Qualifications:

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    • High School Diploma or GED. \n
    • Demonstrated knowledge of medical terminology and basic familiarity with Current Procedural Terminology (CPT) and International Classification of Disease (ICD) and/or insurance billing background. \n
    • Ability to analyze data given to provide the appropriate information to insurance companies. \n
    • Understanding of revenue cycle functions such as admission, billing, payments and denials. \n
    • Excellent communication skills both verbal and written.\n
      Preferred experience: \n
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      • 2+ years’ experience in authorizations and/or insurance billing.\n
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        Just as Virginia Mason is dedicated to improving the lives of our patients and our community, we are equally dedicated to your professional and personal success. With a wide range of perks that includes a comprehensive compensation and benefits package, and the opportunity to live in one of the most livable cities in the nation, you will find that an opportunity with Team Medicine is one worth taking.   \n

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        We are an equal opportunity/affirmative action employer.\n

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        Experience: 8:00 am - 4:30 pm

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      Prior Authorization Specialist

      Virginia Mason Medical Center
      Seattle, WA

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