Sr Prior Authorization Spclst

About Children’s Minnesota

Children’s Minnesota is one of the largest pediatric health systems in the United States and the only health system in Minnesota to provide care exclusively to children, from before birth through young adulthood. An independent and not-for-profit system since 1924, Children’s Minnesota is one system serving kids throughout the Upper Midwest at two free-standing hospitals, nine primary care clinics, multiple specialty clinics and seven rehabilitation sites. As The Kids Experts™ in our region, Children’s Minnesota is regularly ranked by U.S. News & World Report as a top children’s hospital. Find us on Facebook @childrensminnesota or on Twitter and Instagram @childrensmn. Please visit childrensMN.org.

Children’s Minnesota is proud to be recognized by Modern Healthcare as one of 2023’s Top Diversity Leaders. The national honor recognizes the top diverse healthcare executives and organizations influencing public policy, care delivery, and promoting diversity, equity and inclusion in their organizations and the industry.

Department Overview

The Patient Registration and Insurance Verification department is involved in gathering demographic and insurance information for inpatients, outpatients, surgical patients and Emergency Department patients.

Position Summary

The Sr Prior Authorization Specialist promotes an excellent patient experience by ensuring authorizations are in place for services performed at Children's Minnesota prior to their admission to our facilities to secure payment and reduce the out of pocket costs to our patients and families.

This position is responsible for all duties associated with prior authorizations including reviewing insurance benefits, understanding third party requirements, securing authorizations for services, appealing pre-service authorization denials, and appealing authorization related claim denials.

Location (e.g. remote or on-site): Remote

DHS Background Study Required? No

License/Certification/Registration required? No

Education:

• High School Diploma or GED
• Post-secondary education in a related field preferred.
  
  

Experience:

• Three years' experience in a healthcare or related field.
• Preferred experience: Three years' experience in medical billing/prior authorization/insurance.
  
  

Knowledge/Skills/Abilities:

• Knowledge in governmental and commercial payors, medical billing requirements, and prior authorizations.
• Demonstrated knowledge of Prior Authorization operations and medical office and/or hospital procedures.
• Ability to interpret and cascade payor requirements as they relate to insurance prior authorizations.
• Ability to effectively work in both a team environment and independently.
• Ability to establish and maintain effective working relationships with providers, patients, families, and employees.
• Ability to effectively work in a remote environment and connect via multiple communication channels (phone, email, text, etc.).
• Knowledge of how prior authorization functions impact billing, clinical teams, the quality of care and the patient experience.
• Ability to meet and exceed departmental quality, production and prior authorization standards.
• Ability to review and resolve denials pertaining to Prior Authorizations.
• Ability to suggest workflows that improve efficiency and experience.
• Ability to mentor and motivate a remote team that delivers exceptional customer service via multiple communication channels (phone, email, text, etc.).
• Skill in Microsoft Office.
• Skill in written and oral communication.
  
  

Physical Demands

Please click here to view the Physical Demands

The posted salary represents a market competitive range based on salary survey benchmark data for similar roles in the local or national market. When determining individual pay rates, we carefully consider a wide range of factors including but not limited to market indicators for the specific role, the skills, education, training, credentials and experience of the candidate, internal equity and organizational needs.

In addition to your salary, this position may be eligible for medical, dental, vision, retirement, and other fringe benefits. Positions that require night, weekend or on-call work may be eligible for shift differentials or premium pay.

All job offers are contingent upon successful completion of an occupational health assessment, drug screen, background investigation, and compliance with the U.S. Government Form I-9, Employment Eligibility Verification.

Children’s Minnesota is proud to be an equal opportunity employer whose staff is representative of its community and considers qualified applicants for open positions without regard to race, color, creed, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.