Role Description 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
• Appealing authorization related claim denials

Qualifications

• High School Diploma or GED
• Post-secondary education in a related field preferred
• Three years' experience in a healthcare or related field
• Preferred experience: Three years' experience in medical billing/prior authorization/insurance

Requirements

• 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

Benefits

• 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