About Montrose Regional Health:

As the leading healthcare in the Uncompahgre Valley, MRH offers patients personalized and professional healthcare backed by the latest technology experience, and partnership, we continue to evolve and broaden our comprehensive services in 23-specialties and sub- specialties. We are the hospital, the healthcare resource, and the employer of choice in our communities. Montrose Regional Health is a not for-profit accredited by the Joint Commission meeting the highest standards of healthcare.

About The Career:

The Hospital Prior Authorization Specialist is an advocate for the patient's medical needs and financial health as they facilitate the process from provider through payer to patient for timely health care diagnostics and treatments. The Prior Authorization Specialist supports the provider and patient's plan of care as they secure payer authorization for medical services and optimize patient health outcomes by minimizing interruptions to ongoing treatments due to payer coverage restrictions or denials.
Secondly, the Prior Authorization Specialist minimizes the patient's financial risk with a thorough review of the health plan benefits and coverage restrictions, proactively advising the provider and patient of any authorization delay or denial. The Prior Authorization Specialist also decreased the Hospital financial risk by interpreting the provider's clinical documentation for medical necessity requirements, utilizing available clinical resources for documentation improvement, and facilitating appeals for coverage denials.
Schedules patient procedure or surgery to ensure timely and accessible care. Collaborates with various departments to utilize surgery space effectively. Coordinates scheduling with providers and manages pre- and post-op appointments and completion of all related paperwork. Interacts with patients in person and via phone for scheduling, prior authorization and all insurance related updates. Utilizes multiple scheduling software programs.

All About You:

High school diploma or GED; Prior Authorization experience preferred.
Able to achieve minimum level of core competencies and knowledge of procedure authorizations.
Basic understanding of human anatomy.
Identifies primary and secondary payers, based on established payer coverage guidelines and criteria.
Ability to prioritize workflow to meet deadlines.

What We Offer:

Our Brand:

* This position is located in Montrose Colorado

S. Ge, M. Go

Learn more about this Employer on their Career Site

Prior Authorization Specialist and Scheduler - Urology - Full Time