• Job Description

  Req#: 175532

  Overview

  Join an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! Providence Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

  Providence Medical Center, located near I-435 and Parallel Pkwy in Kansas City, Kansas, offers an extensive array of diagnostic and medical care. Key services include nationally recognized cardiovascular care, critical care, surgery, neurosurgery, orthopedics, pulmonary services, 24/7 emergency services and wound care center. The hospital is accredited by The Joint Commission and is a member of Prime Healthcare. For more information visit www.providencekc.com or call 913-596-4000.

  We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

  Responsibilities

  We are seeking a Prior Authorization Scheduler, internally referred to as our Scheduler in our outpatient registration department at Providence Medical Center (Kansas City, KS) a member of Prime Healthcare. The Prior Authorization Scheduler ensures that medical services are authorized in advance, patients receive timely care, and the hospital can bill insurance without issues. This role is important for streamlining operations, reducing claim denials, and enhancing the patient experience in outpatient settings.

  Shift’s Available: Days – Monday thru Friday (8:00am to 4:30pm)

  Employment Type: Full Time – No weekends

  Hours: 8hr shifts

  Essential Duties and Responsibilities (includes, but not limited to):

  • verify insurance coverage, which will involve reviewing patients’ insurance coverages and benefits, ensure that the procedure or treatment falls within the insurance policy’s scope and is covered
  • obtain prior authorization, which will include contacting insurance companies for pre-approval for specific outpatient services, such as Cardiac Cath Lab, Radiology, Respiratory Therapy, Infusion units or any other location where scheduling of a test or procedure may occur
  • submit the necessary documentation, clinicals notes, or referrals required by the insurance provider of the patient
  • work closely physicians, nurses, and other healthcare providers to gather the necessary medical information, such as diagnosis codes, procedure codes, and clinical justifications, that insurers require for approval
  • once authorization is received, confirm the patient's appointment, schedule with the right department, specialist, or technician needed for the procedure which will prevent delays or denied insurance claims
  • inform patients if their insurance has authorized the procedure or if there are any issues, such as denial or the need for additional documentation, explain the patient’s financial responsibility if the procedure is only partially covered or not covered at all
  • keep a detailed log of prior authorization requests, approvals, denials, and any appeals filed, ensure approval numbers and communication with insurance companies, is record in the patient file
  • ensure the hospital follows all regulatory and insurance company guidelines for pre-approvals to avoid compliance issues or financial penalties

  Qualifications

  EDUCATION, EXPERIENCE, TRAINING

  • high school graduate or GED Equivalent Required (effective 4/1/14 for all new hires)
  • knowledge of multiple insurance authorization requirements
  • 1-2 year previous experience in a hospital environment preferred
  • knowledge of medical terminology
  • effective written and verbal communication skills
  • ability to multi-task, prioritize needs to meet required timelines
  • analytical and problem-solving skills
  • customer Services experience required
  • strong clerical and computer skills

  #LI-JJ3

• About the company

  Prime Healthcare Services is an American private healthcare company.

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