Description

InterCare is a Federally Qualified Health Center which MAY qualify employees for National Student Loan Forgiveness program.

Become part of a Migrant and Community Health Center, where you will:

Have a passionate purpose.
Do worthwhile work.
Make a difference in people’s lives.

InterCare is searching for a Full-Time Prior Authorization Nurse or Specialist to join our team! At InterCare, you’ll find a rewarding and challenging work environment and a competitive compensation with pay starting at $20.77/hr. and benefits package which includes: vacation/personal paid time off, sick time, 10 paid holidays, tuition reimbursement program, medical, prescription, dental, vision, life insurance, and short term and long term disability insurance.

At InterCare Community Health Network, we believe all people have the right to equal access to quality health care.

Work Hours

Monday - Friday: 8:00 a.m. - 5:00 p.m., with evening and weekend hours as necessary.

Minimum Requirements

Clear knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD).
Possess a thorough understanding of medical terminology, health care, health plans and the prior authorization process typically acquired through completion of an LPN or RN license.
Practical experience in a professional healthcare environment.
Current state license as an RN or LPN preferred.
Previous Prior Authorization Experience STRONGLY preferred

Primary Accountability

The Prior Authorization Nurse or Specialist (Diagnostics) is responsible for managing the day-to-day submission and follow-up of prior authorizations in a manner that best serves our patients.

Description Of Primary Attributes

Submits prior authorization requests with all required documentation to health plans.
Recognizes and understands clinical documentation pertinent for obtaining prior authorizations.
Reviews prior authorization requests for appropriate documentation, following health plan guidelines and policies.
Ensures all supporting documentation from outside sources are included with initial prior authorization request.
Understands and applies health plan prior authorization requirements and stays current with health plan changes.
Maintains consistent follow-up on status of all prior authorization requests
Communicates notification of delays, denials and approvals of prior authorizations to clinical staff within various service lines.
Facilitates nurse-to-nurse review with health plans or if denied, follows up with provider to request a peer-to-peer review.
Performs retro-review including submission of documentation to health plan.
Effectively communicates with patients and outside organizations.
Contacts patient to collect additional information, including insurance information when not available in the electronic health record.
Submits prior authorization approval codes.
Maintains open lines of communication in relation to authorization approvals and denials.
Effectively utilizes interprets all software tools that assist with prior authorization materials
Keep up-to-date on each of the health plan platforms
Utilize outside electronic health records to supplement necessary documentation

Requirements

General Development

Demonstrates a high degree of organization and accuracy.
Ability to work effectively with a wide variety of people and develop professional working relationships with provider and insurance carriers.
Possesses skills in motivation, self-direction, and punctuality. Demonstrates a strong work ethic.
Demonstrates the ability to work well as part of a team and keep team members updated on current process developments.
Demonstrates the ability to think creatively, juggle multiple priorities, adjust to changing circumstances, organize time efficiently and remain attentive to details.

Technical Skills

Proficient in EHR and EPM
Ability to use and respond to email
Ability to use other InterCare desktop, including Safety Zone, eLearning and iTAC
Ability to navigate through various hospital software applications
Demonstrates critical thinking and ability to analyze information and problem solve

Communication Skills

Possesses a professional level of written and verbal communication skills
Ability to communicate complex concepts in a clear effective manner
Possesses excellent cross cultural communication skills and the ability to communicate with internal and external staff members at all levels

Physical Demands

Job duties are performed in the typical office environment of the organization, which requires ordinary ambulatory skills sufficient to visit other locations. The environmental factors and/or physical requirements of this position include the following:

Ability to stand, walk, stoop, kneel, crouch, frequently sit, and lift up to 25 lbs
Requires good hand-eye coordination, reach with arms & hands, and finger dexterity, including ability to grasp, and manipulate (using keyboard, office equipment)
Visual acuity to use keyboard, operate office equipment, and read printed material and regularly required to talk and hear

MDSI

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Prior Authorization Nurse or Specialist