Prior Authorization

Prior Authorization

MHSC is an equal employment opportunity employer and does not discriminate on the basis of gender, age, race, color, creed, religion, national origin, marital status, sexual orientation, gender identity, mental or physical disability or uniformed services status. MHSC is dedicated to fostering an inclusive environment that recognizes the contributions and supports the advancement of all because an inclusive environment can enhance the quality of healthcare, improve hospital / community relations, and positively affect the health status of society. No candidate will be rejected based on any of the above or any disability that, with reasonable accommodation, does not prevent performance of the essential job duties.

MHSC is committed to the “Planetree” methodology of “Person-Centered Care”. Person-Centered Care is more than hospitality. It is more than amenities and inviting surroundings. Person-Centered Care is an evidence-based framework for improved patient and family engagement, better clinical outcomes, increased staff retention / recruitment, and high value care. Person-Centered Care creates workplaces that energize and inspire joy. It places patients and caregivers at the center of the care experience and unites communities around health and wellness. This approach also focuses on supporting the professional and personal aspirations of healthcare professionals who can more effectively care for others when they feel cared for themselves.

JOB SUMMARY

This individual is responsible for answering all incoming phone calls for Memorial Hospital of Sweetwater County in the Prior Authorization department. They are responsible for updating or obtaining accurate demographic, financial, medical record, and insurance information in our computer system. This individual is responsible for running eligibility verification on all self-pay entitlements, and commercial insurance accounts to ensure accurate demographic information; reviews all visits related to insurance benefits / limitations and preauthorizes all required services. Identify in-house patients ensuring that all patients requiring pre-authorization are authorized in a timely manner, completing all inpatient reports within the designated time frame. They will accurately calculate patient copayments, co-insurance and deductibles, receiving payments and accurately posting any monies received, identify patients who might need financial counseling based upon their inability to pay, creating financial agreements with patients based on hospital policies and procedures and / or referring patient to the Patient Navigation team for financial assistance. This individual will preauthorize with a complete and accurate CPT and ICD10 code for each service / procedure and diagnosis. Responsible for contacting patients prior to outpatient services giving the patient knowledge of accounts payable for the date of service; ensures that patient is pre-admitted with accurate and comprehensive information. This individual must believe in and promote the mission and vision of Memorial Hospital of Sweetwater County.

JOB QUALIFICATIONS

Education :

High School diploma or equivalent.

Job Knowledge and Skills :

Excellent communication skills, data entry, and basic computer skills, typing 40 wpm.

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