Prior Authorization Specialist

RiverView Health, is a community owned, membership based non-profit organization that was formed in 1898 and continues to be the sole community hospital in Crookston, MN.

RiverView Health operates a 25 bed Critical Access Hospital, RiverView Recovery Center; a chemical dependency outpatient treatment program, RiverView Home Care and five primary care and specialty clinics in the hospitals service area.

We have a robust scholarship program for those furthering their education in a medical field, excellent benefits, and a friendly work environment. Full-time benefits include health insurance, free single vision and basic dental insurance, life insurance, long-term disability and short-term disability, and employer HSA contributions. Other benefits include employer pension matching, shift differential, incentive/premium pay, free annual biometric screening and paid volunteer time off.

RiverView is an Equal Employment Opportunity employer. 

Full-time - Prior Authorization Specialist

Location: Hospital - on site

Position Status: 1fte (80 hours per pay-period) - Non-Exempt subject to over-time

Schedule: 80 hours per pay period

Pay Range: $20.53 - $28.74 (based on experience) - benefitted position.

RiverView Health has an opening for a Full-Time - Prior Authorization Specialist who is responsible for securing timely and accurate prior authorizations for medical services, procedures, medications, and equipment. This role ensures compliance with payer requirements and supports efficient patient care delivery by minimizing delays due to authorization issues.

• Verifies patients’ demographic, insurance, and benefits information
• Obtains pre-authorization and pre-certifications from third-party payers in accordance with payer requirements, and documents the authorization number and period of validity in the EMR system (EPIC)
• Gathers additional medical records from other providers as needed to support medical necessity when obtaining a pre-authorization, and follows up with payers on pre-authorization requests as needed
• Alerts the clinicians involved in the patient’s care when there are issues with referrals or complications with insurance coverage
• Maintains accurate records of authorizations within the EMR system (EPIC)
• Identifies patients who will need to received Medicare Advance Beneficiary Notices of Noncoverage (ABNs)
• Refers accounts to financial counseling as needed if authorization is not obtained
• Works with business office staff to support appeal efforts for authorization-related denials
• Complies with HIPAA regulations, as well as the organization’s policies and procedures regarding patient privacy and confidentiality
• Maintains professional tone at all times when communicating with patients and payer representatives
• Performs other duties as requested

Education/Certifications/Licenses/Experience:

Required:

• High school diploma or equivalent (GED) required
• 1 year related working experience in healthcare

Preferred:

• Associate’s degree in healthcare or business administration and/or related/comparable experience preferred 
• Certification in medical billing/coding (e.g., CPC, CPAR, or CHAA)
• 2+ years medical billing experience