Prior Authorization Specialist

Rapid City Medical Center is seeking a Prior Authorization Specialist to join our West River ENT team! This position is responsible for managing the prior authorization process according to RCMC policies and procedures. It serves as an integral part of the patient care team while acting as a liaison between patients and clinical staff to deliver outstanding service and optimize patient flow. 

JOB DUTIES: 

• Serves as a member of the clinic care team by providing service that further facilitates the ongoing care of that patient.
• Initiates prior authorizations as required by payers for diagnostic imaging procedures and specialized medications.
• Accurately processes prior authorization requests in accordance with RCMC policy and procedures and communicates back to nurse/provider team in a timely manner.
• Accountable to achieve prior authorization processing productivity and accuracy standards.
• Protects and maintains confidentiality and privacy of all prior authorization and member information.
• Demonstrates ability to appear for work on time, knowledge of medical terminology, follow directions from a supervisor and interact well with coworkers and patients.
• Develop, document, and maintain a prior authorization matrix for all payers.
• Maintains confidentiality of all pertinent information to assure that employee, patient, and visitor rights are protected.
• Handles all information regarding the organization in a manner that assures strictest confidentiality is maintained at all times.
• Calls on allergy and hearing aid benefits.
• Other responsibilities as assigned based on business needs.

EDUCATION: High school diploma.

EXPERIENCE:  Minimum of one year work experience in medical service.

KNOWLEDGE: 

• Experience in business/professional written and verbal communication.
• General understanding of medical terminology, insurance billing, or coding background desirable.
• Exceptional customer relation skills.
• Intermediate level of computer knowledge with experience in Microsoft Office Products.

ABILITIES:

• Must be self-motivated, have the ability to prioritize work, and meet deadlines in an environment which is often stressful and fast-paced.

• Requires ability to make independent judgments.

• Organize and utilize time in an efficient fashion to assure all tasks are completed in a timely manner.
• Demonstrates a commitment to providing the highest and most reliable quality service available on a daily basis.
• Demonstrates ethical conduct and practices.

PHYSICAL/MENTAL DEMANDS: 

• Ability to walk, stand, and sit for periods of time. Ability to sit and review information on a computer screen for extended periods of time.
• Normal motor skills and eye-hand coordination
• Must have manual dexterity to operate computer keyboard and standard office equipment
• Occasional stress from dealing with multiple projects.

This job description is intended to describe the essential job functions of this position and is not intended to be an all-inclusive statement of job responsibilities.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or veteran status.