Prior Auth & Credentialing Specialist

Gothenburg Memorial Hospital•Gothenburg, NE

just now•Onsite

About The Position

The Prior Auth & Credentialing Specialist is responsible for maintaining facility and provider enrollment with payers. They will serve as the liaison with 3rd party to provide information and data as needed to maintain and establish enrollment. Responsible for obtaining contracts with the payers for the facility to know payment guidelines. Works with ordering providers to vet prior auth on tests/exams being ordered. This position reports to the Revenue Cycle Director.

Requirements

High school diploma or GED required.
Knowledge of RHC and CAH guidelines.
Knowledge of insurance guidelines, including HMO/PPO, Medicare, and Medicaid plans.
Healthcare experience required.

Responsibilities

Prepare and obtain contracts for payers to be reviewed by the CFO prior to initiating said contracts.
Keep payer matrix spreadsheet up-to-date and current with any changes.
Maintain an open communication channel with 3rd-party credentialing bodies and provide information as requested and necessary for payer credentialing processes.
Work with providers to vet prior authorizations for tests and exams being ordered, initiate the prior authorization process, and provide necessary clinical documentation as requested by payers for authorization processes.
Assist Patient Accounting with answering phones and handling patient billing questions.