Description

Brattleboro Memorial Hospital /

Southern Vermont Health Services Corporation

Job Description

Job Title: Patient Access Pre Reg and Prior Auth Rep

Job Code: 755 

FTE: 1 

Hours: 8:00am - 4:30pm

Weekend Schedule: N/A

Holiday Schedule: N/A

FLSA Status: Non-Exempt

Department Name: Patient Financial Services

Location: Brattleboro, Vermont 

JOB SUMMARY:

The Prior Authorization Representative is responsible for all aspects of the prior authorization process for ambulatory, outpatient, inpatient, and infusion services at BMH. Responsibilities include collecting all the necessary documentation for complete, timely, and accurate identification and submission of prior authorizations. Perform functions related to denials, appeals, and retro-authorizations. Interact with various internal departments, insurance companies, and patients, in a friendly helpful manner. Document account activity and update patient and claim information to ensure all functionalities are utilized for the most efficient processing of claims. Identify prior authorization trends and/or issues that may result in delayed claims processing. Provide coverage periodically with outpatient registrations and pre-registrations, as needed (Patient Services Representative). Treat patients with utmost courtesy and respect in accordance with the Patient Bill of Rights. Work shifts as directed, demonstrating flexibility with vacation, holiday and sick call outs to support the operations of the department. Maintain knowledge of, and complies with, all relevant laws, regulations and policies, procedures and standards. Actively participate in creating and implementing improvements to achieve patient satisfaction. This position reports directly to the Supervisor of Prior Authorizations.

DEPT. SCOPE OF SERVICE:

The Prior Authorization Department is primarily responsible for insurance verification and obtaining prior authorization for future and scheduled appointments/referrals. This department reviews denials, appeals, and retro-authorizations related to prior authorization. As a sub-department of Patient Financial Services, Prior Authorization Department will assist with pre-registration and in person registration as needed. 

Requirements

EDUCATION:

•  High School diploma required, and associate degree preferred. 

EXPERIENCE/SKILL SETS:

• Prior Customer Services Experience required
• Preferred in a medical office/hospital setting.  
•  Experience with standard Microsoft Office applications, i.e Outlook, Word, Excel and other data entry processing applications 
•  Strong oral and written communication skills with all levels of the organization and with external contacts 
•  Prior Experience with Prior Authorization, Utilization Review, Medical Billing/Coding, or Patient Registration preferred 
• Knowledge of Medical Terminology and Pharmaceuticals preferred. 
•  Experience with EMR/EHR systems preferred. 
• Strong Analytical and Problem-Solving Skills 
•  Demonstration of strong organizational and time management skills 

LICENSURE/CERTIFICATION(S):

• None

OSHA CATEGORY

• OSHA Category I - Tasks that involve exposure to blood, body fluids, or tissues require use of techniques of Universal Precautions as evidenced with blood borne pathogens standards.

PHYSICAL DEMANDS

• On-the-job time is spent in the following physical activities.
• Standing - Up to 1/3
• Walking - Up to 1/3
• Sitting - 2/3 or more
• Talking or Hearing - 2/3 or more
• Use of hands to finger, handle or feel - Up to 1/3
• Pushing/Pulling - None
• Stooping, kneeling, crouching or crawling - None
• Reaching with hands and arms - Up to 1/3
• Tasting or smelling - None

This position requires that weight be lifted or force be exerted.

• Up to 10 pounds - 2/3 or more
• Up to 25 pounds - 1/3 to 1/2
• Up to 50 pounds - Up to 1/3
• Up to 100 pounds - None
• More than 100 pounds - None

This position has special vision requirements.

• Close Vision (clear vision at 20 inches or less)
• Color Vision (ability to identify and distinguish colors)
• Ability to Adjust Focus (ability to adjust eye to bring an object into sharp focus)

WORK ENVIORNMENT

• This position requires exposure to the following environmental conditions.
• Wet, humid conditions (non-weather) - None
• Work near moving mechanical parts - Up to 1/3
• Fumes or airborne particles - Up to 1/3
• Toxic or caustic chemicals - Up to 1/3
• Outdoor weather conditions - None
• Extreme cold (non-weather) - None
• Extreme heat (non-weather) - None
• Risk of electrical shock - None
• Work with explosives - None
• Risk of radiation - None
• Vibration - None
• The typical noise level for the environment is:
• Very Quiet
• Quiet
• Moderate Noise
• Loud Noise
• Hearing
• Ability to hear calls
• Ability to hear instructions from physician/department staff/others

EEO/ADA Statement

Brattleboro Memorial Hospital provides equal employment opportunities to all applicants and employees and strictly prohibits any type of harassment or discrimination in regard to race, religion, age, color, sex, disability status, national origin, genetics, sexual orientation, protected veteran status, gender expression, gender identity, or any other characteristic protected under federal, state, and/or local laws.

Consistent with the Americans with Disabilities Act (ADA), it is the policy of Brattleboro Memorial Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact Human Resources.

Compensation Disclosure in Accordance with Vermont Act 155

In compliance with Vermont Act 155, Brattleboro Memorial Hospital provides the compensation range for this position in good faith. The listed range represents the pay scale reasonably expected for a successful candidate based on factors such as relevant experience, education, internal equity, and market competitiveness. Final compensation will be determined during the hiring process.