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Providence Authorization Specialist in Portland, Oregon

Description:

Providence is calling a Authorization Specialist to the Diagnostic Imaging Administrative Support Department at Providence Portland Medical Center in Portlnad, OR. This is a full-time (1.0 FTE), day shift position.

Apply today! Applicants that meet qualifications will receive a text message with some additional questions from our Modern Hire system.

We are seeking a Authorization Specialist who will be working with physician offices, inside and outside the Providence organization, in order to facilitate proper handling of exams requiring pre-certifications, referrals or any kind of authorization from an insurance company. This position serves as an expert resource to Diagnostic Imaging staff in regard to the specialist referral/prior authorization requirements for multiple contracted and non-contracted insurance plans, diagnostic imaging protocols that vary between the multiple facilities/sites providing this service, and processes relating to these functions.

This position reports to the Regional Scheduling Manager.

MAJOR CHALLENGES:

  1. Staying current with constant changes in multiple insurance companies' policy changes, specialist panel and referral/prior authorization processes and adapting these changes quickly into daily workflow.

  2. Interpreting the Diagnostic Imaging Scheduling Program to providers and staff in a manner that reflects the positive nature of the program's strategies and goals.

  3. Functioning as a liaison and problem solver for multiple internal and external customers.

  4. Managing multiple priorities and timelines efficiently and effectively to ensure all imaging exams are authorized and covered.

  5. Identifying and responding to requests that require immediate determination.

  6. Defusing potential conflicts and negotiating solutions while maintaining good customer service and excellent working relationships with coworkers and external contacts.

In this position you will have the following responsibilities:

  • Proficient in the principle duties or functions of Referrals, Prior Authorizations, Diagnostic Imaging Scheduling and Radiology Billing.

  • Act as a resource and lead contact for the Regional Scheduling departments and provides technical assistance to the clinical staff and/or medical directors on patient's coverage, authorization guidelines and procedures, diagnostic imaging protocols, coding systems, claims research, contracted specialist network and billing.

  • Use cheduling systems and understands differing protocols for diagnostic imaging services at multiple Providence facilities and freestanding diagnostic imaging centers within specified timeframes. Clearly communicates and confirms patient understanding of any issues with authorization or coverage for scheduled diagnostic imaging exams.

  • Work with peers and others to resolve service or production problems. Serves as a liaison and resource to the patient, clinic staff and the patient's insurance plan for problem resolution purposes in regard to referrals, authorizations and diagnostic imaging scheduling services.

  • Develop or revise, or assist to develop or revise written documentation for referral processing, and diagnostic imaging scheduling including department or unit policies, procedures, work flows, current diagnostic imaging protocols for each Providence Health and Services facility, insurance plans and contracted specialist and facility updates.

  • Process all paperwork/forms related to out of pocket payments, including waivers and patient liability forms.

  • Assist with appropriate CPT and/or ICD-10 diagnosis coding as needed to comply with insurance coverage guidelines.

Qualifications:

Required qualifications for this position includes:

  • High School Diploma or GED

  • 3 years experience in a utilization management functional area such as prior authorization, medical audit, appeals or delegation

  • 2 years additional years in a business environment doing authorization work, insurance verification, referrals, and/or denials

  • Knowledge of CPT and ICD-10 coding, medical terminology, anatomy and physiology and general knowledge of health care environment and delivery systems

  • Requires knowledge of coding, medical terminology, insurance billing, claims and managed care principles

  • Requires excellent verbal communication, negotiation and interpersonal skills

  • Requires proficiency in data processing skills, such as word processing and email

Preferred qualifications for this position include:

  • Bachelor's Degree in Healthcare Administration or work experience in a medical clinic or managed care/health insurance plan (3 years in a related field)

  • CMA or MA with clinical experience working in clinic setting

  • Logician and Pathways® software experience

  • Experience in database management and spreadsheets

  • Working knowledge in a utilization management functional area such as prior authorization, medical billing, appeals or delegation

  • Knowledge of database management and spreadsheets

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Patient Services

Location: Oregon-Portland

Req ID: 299105

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