Mountain View Hospital is looking for a Pre-Authorization/Denial Insurance Specialist to join our team!

JOB SUMMARY:

Works to be sure all insurance is correct and appropriately entered into system. Verifies benefits and helps to coordinate patient assistance programs when necessary. Checks proposed treatment to make sure the diagnosis will support medical necessity as per insurance company and verify that all visits and diagnostic tests that need preauthorization are done.

BENEFITS:

Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

DUTIES AND RESPONSIBILITIES:

• Responsible for verifying insurance benefits and eligibility on pain management patients. Responsible for obtaining preauthorization for diagnostic tests, scans and therapeutic injections.
• Communicates appropriately and clearly to the patients, supervisor, nurse managers, coworkers and physicians.
• Assists with insurance denials and the appeal process. Helpful in researching patient accounts for insurance payment issues.
• Maintains department records, reports, forms and files.
• Maintains communication with referring physicians, insurance providers and staff to help ensure continuity of care.
• Verifies patients have appropriate diagnosis for each plan of care to support medical necessity, insurance is pre-certified if necessary, and obtains a commitment for payment arrangements from patient when necessary prior to treatment.
• Responsible for resubmitting insurance denials and appeals, communicating with physicians and coworkers with results
• Communicates with worker’s compensation and VA Administrations to obtain approval for services.
• Responsible for knowing hospital policies and being familiar with hospital services that are available.
• Know the difference between routine and emergent authorization requests and when to use them.
• Demonstrates an ability to be flexible, organized and function well in stressful situations.
• Demonstrates ability to multi-task efficiently.
• Maintains flexibility as department grows with willingness to accept additional responsibilities requested by department director.
• Treats patients and their families with respect and dignity; ensures confidentiality of patients’ records.
• Maintains a good working relationship both within the department and with other departments.
• Participates in the educational program, completes annual educational requirements, and attends in-service meetings as required.
• Maintains confidentiality when responding to medical records requests
• Verifies correct documentation is on file for medical record requests and ensures that duplicate requests are taken care of properly
• Responds to requests in a timely manner
• Works to provide functional and safe surroundings for patients and staff (i.e., safety, security, infections control, etc.). Strives to always promote personal and patient’s safety. Demonstrated awareness of the location of applicable hospital and department specific manuals.
• Attends all meetings as required.
• Willingness to do assignments, cross-training, or tasks within the scope of his/her job description, as asked by the manager, which are deemed necessary to meet the needs of the department.
• Maintains patient confidentiality at all times.
• Must maintain accurate time clock punches, punch in and out according to hospital policy.
• Answers incoming calls to the facility in a professional, timely manner.
• Accepts and completes other duties as assigned or requested.

ABOUT MOUNTAIN VIEW:

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

Education/Certification: High school diploma or general education degree (GED).

Experience: Must have 1-5 years medical terminology experience. Experience with medical insurance is required.

Equipment/Technology: Ability to use hospital information system and operate basic computer functions and software.

Language/Communication: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Employee must possess the ability to speak effectively, before groups of customers and or employees of the organization. Good telephone skills are a must.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Employee must possess the ability to compute rate ratios and percentages and to draw and interpret bar graphs.

Mental Capabilities: Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form. Employee must possess the ability to deal with problems involving several concrete variables in standardized situations.

Interpersonal: Ability to work well with others as well and be approachable.