Prior Authorization Specialist

Why M Physicians?

The Prior Authorization Specialist is responsible for overseeing all aspects of the prior authorization process to ensure timely and accurate insurance verification and securing authorization approvals for medical procedures, diagnostic tests, medications, and other healthcare services provided by University of Minnesota Physicians.

What you will do as a Prior Authorization Specialist:

• Perform thorough insurance verification to confirm patient eligibility and coverage.
• Communicate with insurance companies to clarify coverage, policies, and documentation requirements.
• Ensure timely and accurate processing of prior authorizations for medical procedures, diagnostic tests, medications, and other healthcare services.
• Serve as a liaison between healthcare providers, patients, and payers regarding authorization status and financial obligations.
• Monitor and follow up on pending authorizations to ensure approvals prior to services being performed.
• Enter and update insurance and authorization information in the Electronic Medical Record (EMR) and billing systems.
• Communicates with provider and/or clinic operations regarding status of prior authorizations and issues.
• Communicates with patients when an authorization is not able to be secured, provides options, and de-escalates concerns when they arise relating to denials and/or cancellation of cases/procedures.
• Educates patients on payment expectation, collects pre-payments and verbal financial responsibility agreements, when necessary, for a patient to proceed with their care.
• Address a wide variety of issues and concerns with minimal supervision, ensuring timely resolution of cases to support continuity of care and organizational goals.
• Resolve authorization-related denials by submitting appeals or retroactive requests when appropriate.

What you will need:

• High school diploma or GED.
• 2+ years in insurance resolution, patient accounting or medical billing with exposure to medical terminology, financial securing, collections and patient interaction; or new graduate from an HIM related program with equivalent knowledge.
• Experience with medical terminology, medical financing, health plans and payer information including the prior authorization process.
• Experience with ICD-10-CM and CPT code knowledge/experience.

Location: Hybrid/Remote 720 Washington Ave SE Suite 200, Minneapolis, MN 55414

Hours: 1.0 FTE

Benefits: This is a fully benefit eligible position: Competitive wages, Healthcare (including vision & dental), 401K, parking & tuition assistance and more!

Compensation:

At M Physicians we believe in pay transparency and equity. The compensation for each position is based on experience, skills, qualifications, and other role-specific considerations. Our total compensation is designed to support your well-being, career growth, and work-life balance.

University of Minnesota Physicians (M Physicians), a non-profit organization headquartered in Minneapolis, seeks motivated individuals for both clinical and non-clinical roles to drive innovation in health and medicine. Our inclusive culture offers competitive salaries, excellent benefits, and the opportunity for career development in the exciting field of health care to over 1,200 physicians, 300 advanced practice providers, and 2,200 health professionals and staff across Minnesota and beyond.

Join us on a mission to advance medicine.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.