Business Services & Prior Authorization Specialist - Long Term Care | Full-Time

Position: Business Services & Prior Authorization Specialist - Long Term Care

Department: Business Services

Location: Glencoe, MN

Remote Work: No

Position Type: Full-Time

Hours Per 2-week Pay Period: 64

Shift: Days

Schedule: Monday-Friday - Flexible between 7:00 a.m. - 5:00 p.m.

Weekend Rotation: No

Holiday Rotation: No

Glencoe Regional Health (GRH) fosters a culture that cares. Our mission is to improve every life by offering high-quality, safe, and accessible healthcare. We stive to be both the provider of choice and the employer of choice. Our family of care includes a critical access hospital, skilled nursing facility, independent senior apartment complex, and three primary care clinics.

Position Summary:

This position will work in insurance billing and prior authorization.

The Business Services Specialist is responsible for processing all skilled nursing facility claims both electronically and by paper claim submission. They are responsible for gathering and updating insurance information as it changes and assuring that the claim gets submitted to the appropriate insurance company. The Specialist must proof claims to ensure that all diagnosis codes are present, add modifiers, if necessary, add provider numbers if needed, etc. They are responsible for following up with denials and rejections from the insurance companies. This person must be capable of working with residents, families, and third-party organizations in a friendly and professional manner regarding the accuracy and completeness of the charges processed.

The Prior Authorization Specialist is responsible for coordinating and processing medical prior authorizations and referrals for procedures by reviewing insurance and submitting information needed for coverage. This role will process referrals in electronic and paper formats, handle prior authorization requests from patients and other facilities, answer patient, resident, and family questions, and maintain prior authorization tracking systems. This position will ensure documentation and respond to all inquiries. Completes all necessary prior authorizations and follow-up procedures, tracking according to facility protocols. This position will process prior authorizations for both skilled nursing and hospital/clinic visits.

Education and Experience:

• High school graduate or equivalent required.
• Bookkeeping/record keeping experience; six months to one-year clerical experience in third party payor insurance processing.
• Strong working knowledge of Excellian/EPIC EMR preferred.

Required Skills and Abilities:

Compensation and Benefits:

Compensation decisions are made based off of several factors including relevant work experience, education, certification and licensure as well as internal equity. It is not typical for an individual to be hired at the top of their hourly range.

Wages are just one part of our employee compensation package. To review our Employee Benefits, visit Employee Benefits | Glencoe Regional Health

Glencoe Regional Health is an equal opportunity employer. We recruit, employ, train, compensate, and promote without regard to any protected characteristics under applicable law.