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*_SUMMARY:_*

We are currently seeking a*Prior Authorization Representative Senior*to join our**Financial Securing**team. This full-time role will primarily work remotely (Days M-F).

*Purpose of this position:*The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating pre-authorizations for patients and often handling cases that need quick turnaround (e.g., last-minute scheduled services). The individual in this role is an expert on payer regulations and contracts, and they serve as a point of contact for peers looking to resolve questions or issues regarding prior authorizations

Current List of non-MN States where Hennepin Healthcare is an Eligible Employer:/Alabama, Arizona, Arkansas, Delaware, Florida, Georgia,//Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Mississippi, Nevada, North Carolina, North Dakota, New Mexico South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin./

*_RESPONSIBILITIES:_*

* Utilizes online systems, phone communication, and other resources to secure prior authorizations within a timeframe before scheduled appointments/procedures/same day surgeries and during or after care for unscheduled patients

* Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the provider/patient, as it pertains to prior authorization

* Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed

* Obtains pre-certifications and prior authorizations from third-party payers in accordance with payer requirements

* Alerts physician offices to issues with verifying insurance and/or obtaining prior authorizations

* Demonstrates expert understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients’ out-of-pocket liabilities, based on prior authorization status

* Follows up on all prior authorization submissions for timely response

* Follows up on any prior authorization denials; assists Utilization Management with appeals, as needed

* Connects patients with financial counselors, as necessary

* Maintains productivity and quality standards and assists other team members when necessary

* Participates in developing and planning process improvements for the department

* Other duties as assigned

* Complies with all state and federal laws and regulations related to patient privacy and confidentiality

*_QUALIFICATIONS:_*

/*Minimum Qualifications:*/

* High school diploma or equivalent

* 2 years clerical experience in health care revenue cycle operations: billing/claims, patient accounting, collections, admissions, registration, etc.

* Bilingual strongly preferred, required in some positions

-OR-

* An approved equivalent combination of education and experience

/*Preferred Qualifications:*/

* Experience working in EPIC, preferred

/*Knowledge/ Skills/ Abilities:*/

* Requires knowledge of government and commercial payer (Insurance) benefit and eligibility verification, and ability to become aware of and navigate medical policy per payer guidelines

* Demonstrated expertise in logical thinking, data preparation, and analysis

* Comprehensive knowledge of Microsoft Office (Outlook, Word, Excel)

* Strong communication skills, both verbal and written

* Ability to communicate effectively with collaborating departments, providers, and insurance representatives

* Demonstrated organizational skills and the ability to prioritize and manage tasks based on established criteria

* Excellent verbal and written communication and interpersonal skills

* Ability to work independently with minimal supervision, within a team setting and be supportive of team members

* Proficient with Microsoft Office

* Ability to analyze issues and make judgments about appropriate steps toward solutions

**Title:** *Prior Authorization Rep Sr, Financial Securing*

**Location:** *MN-Minneapolis-Downtown Campus*

**Requisition ID:** *251759*