Job Posting
Medical Records and Authorizations Specialist
Position Description
The Medical Records/Prior-Authorization Specialist maintains dictated reports from healthcare providers for
inclusion in medical records in the appropriate format. Patient Access Representative “back-up” in different
office settings. Process medical record requests both internally and from other providers and companies in a
timely and compliant manner. Processes medical record paper charts and files documents in appropriate areas.
Prior-Authorization role will have the responsibility to work with the insurance companies the facility is
contracted with to obtain prior authorizations with those insurances for inpatient visits. Responsible for
performing routine bookkeeping and accounting functions related to the Business office. The ideal candidate
will have the basic knowledge and skills to bill all payers for all hospital, hospital-based physician bills, and
clinic-based physician bills; pursues collection of all claims until payment is made by insurance companies. It
will be the responsibility of this individual to accurately prepare claims every month for therapy services. May
be asked to post insurance remits from insurance. May be responsible for other Business Office related tasks
such as accounts receivable, accounts payable, collections, general secretarial duties, insurance billing,
preparing hospital bills, cash posting and bookkeeping duties.
Desired Education, Certifications and/or Experience
· High school diploma
· Medical terminology experience (preferred)
· Typing/computer experience (preferred)
Responsibilities / Functional Job Description
General: Performance Expectations
1. Responsible - works independently, in a safe and appropriate manner. Demonstrates both problem-
solving and problem-prevention skills.
2. Sensitive - displays sensitivity to the needs of patients and co-workers. Demonstrates good
communications skills and empathy.
3. Timely - recognizes time as a customer's most valuable resource and responds promptly to patients'
and co-workers' needs.
4. Accurate - works carefully and precisely, with attention to detail.
5. Coordinated - organizes and delivers service in the proper order. Displays good organization skills
and utilizes resources wisely. 6. Thorough - meets all the requirements of his/her position. Is able to evaluate and follow up on his/her services. General: Teamwork and Service Expectations 1. Display and encourage sensitivity to needs of patients, visitors, and co-workers. 2. Treat others with consideration, courtesy and respect. 3. Perform duties willingly and with initiative; shares necessary information so co-workers can do the same. 4. Remain composed and takes actions to restore calm in stressful situations. 5. Demonstrate judgment and tact when dealing with others. 6. Cooperate with other hospital departments and work groups. 7. Communicate effectively with patients, visitors, and co-workers; take action to clarify information received from others. General: Standards of Behavior 1. Demonstrates a commitment to living the SLHD standards of behavior through exemplifying in action, a commitment to the values of SLHD, namely: a. Innovation – continually seeking the latest advances in cost effective healthcare and customer service. b. Compassion – concern for the individual, empathy for the situation, action to provide service c. Integrity – doing the right thing; always. d. Community – supporting, giving and acting to improve where we live, serve, and work. e. Passion for Healthcare – fervently, avidly, and zealously seeking the improvement of human health 2. Displays this commitment to the standards of behavior through actions and words, by demonstrating the following behavior traits: a. Adaptability – Responding resourcefully to changes in direction, priorities, schedules, approaches and responsibilities for the good of everyone. Maintaining a positive attitude when faced with a difficult or challenging situation and providing an uplifting and realistic outlook on the opportunities the future may present. b. Communication – Listening attentively and seeking clarification, being friendly in words and actions, responding to others in a timely manner to ensure satisfaction, comfort and quality care. Utilizing AIDET and the promise to explain the experience the patient can expect, and communicate how the patient will receive excellent and timely care. c. Professional Conduct and Attitude – Keeping personal conversations to an appropriate volume for the area I am working in, treating everyone in a courteous manner – rudeness is never acceptable, addressing conflict with others privately and respectfully and utilizing the appropriate chain of command. Doing the right thing, even when no one is watching, keeping frustration separate from patient care and professional activities, and recognizing that patients are not an interruption, they are our reason for being here. d. Commitment to Team Members/Patients – Assist patients in finding their destinations, walking with them when possible, interacting constructively with team members and supporting a blame free environment, recognizing there is no place for “it’s not my job”, finding the right person to support a patient or coworker if I am unable to support or help them. I will not spread negativity, being positive starts with me. e. Personal and Career Development – Demonstrating a curiosity toward learning and practicing self-development. Supporting co-workers by sharing knowledge, expertise and
encouragement to help them be successful in their role. Finding ways to improve the quality of my work even when things are going well. Seeking creative solutions to problems and encouraging creativity in others. f. Sense of Ownership – Admitting and correcting mistakes, taking personal responsibility to help the organization to succeed. Ensuring cleanliness by maintaining a clutter-free environment. Refraining from behavior or conversations that undermine the confidence of the community in our facility. Utilizing resources effectively and maintaining financial responsibility. Role Specific: Work role responsibilities 1. Work accurately and efficiently in a fast-paced environment utilizing computer/typing skills daily. 2. Translate medical jargon and abbreviations into proper form. 3. Organize, prioritize, distribute, and track documentation. 4. Answer phones, schedule appointments and other office reception duties when required. 5. Operate office equipment. 6. Utilize understanding of HIPAA requirements when processing medical record requests. 7. Duplicates medical records, documents, forms and correspondence correctly when records requests are received. 8. Responsible for mailing and faxing copies of medical documents and reports to other physicians and patients. 9. Work well with others throughout the facility. 10. Gathers information from providers to ensure accurate and complete records for the privileging policy in the hospital. 11. Submits information to all payers that the hospital is credentialed with for every provider as part of the onboarding process and as needed for revalidation. 12. Prepares and submits hospital claims to all payers. 13. Secures needed medical documentation required or requested by all payers. 14. Handle all inquiries, phone calls and correspondence relating to billing and insurance claims. 15. May be responsible for other procedures and duties such as accounts payable, accounts receivable, collections, secretarial, reception, etc. 16. Provide back-up coverage for the hospital front desk. 17. Maintains confidentiality of all information. 18. Enhance professional growth and development through in-service meetings, educational programs, etc. 19. Perform other duties as directed by the Manager of the Revenue Cycle.
Desired Knowledge, Skills & Abilities
1. Knowledge of state and federal regulations, policies, and procedures governing
accounting, medical billing, and financial recordkeeping.
2. Knowledge of financial/revenue cycle reporting and key performance indicators for
measuring and benchmarking performance
3. Ability to operate various office equipment.
4. Skill in accuracy and attention to detail.
5. Ability to perform public relations and public speaking in a professional manner.
6. Ability to maintain confidentiality.
7. Ability to solve practical problems and deal with a variety of variables. 8. Ability to work with, lead and supervise others. 9. Ability to manage multiple assignments/projects; meet timelines and prioritize responsibility. 10. Ability to handle stressful situations and react appropriately. 11. Ability to maintain a driver’s license and ability to travel distances for multiple days as necessary. 12. Ability to exercise good judgement in appraising situations and making decisions. 13. Ability to work and interact effectively and positively with other staff members to build and enhance teamwork across SLHD departments. 14. Ability to communicate to complete responsibilities effectively. 15. Ability to see to use computer efficiently and read computer reports and correspondence. 16. High proficiency with Microsoft office products (excel, word, PowerPoint, etc.)
Equal Employment Opportunity
South Lincoln Hospital District will provide equal opportunity employment to all employees and applicants
for employment. No person shall be discriminated against in employment because of race, color, gender, age,
national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual
orientation or any other category protected by law.
Americans with Disabilities Act (ADA) Statement
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential
functions. While performing the duties of this job, the employee is regularly required to sit; use hands to
finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to
stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds. Desired Education, Certifications and/or Experience
• High school diploma
• Medical terminology experience (preferred)
• Typing/computer experience (preferred)
• Basic knowledge of reading and understanding insurance remittances
Responsibilities / Functional Job Description
General: Performance Expectations
1. Responsible - works independently, in a safe and appropriate manner. Demonstrates both problem-solving and problem-prevention skills.
2. Sensitive - displays sensitivity to the needs of patients and co-workers. Demonstrates good communications skills and empathy.
3. Timely - recognizes time as a customer's most valuable resource and responds promptly to patients' and co-workers' needs.
4. Accurate - works carefully and precisely, with attention to detail.
5. Coordinated - organizes and delivers service in the proper order. Displays good organization skills and utilizes resources wisely.
6. Thorough - meets all the requirements of his/her position. Is able to evaluate and follow up on his/her services.
General: Teamwork and Service Expectations
1. Display and encourage sensitivity to needs of patients, visitors, and co-workers.
2. Treat others with consideration, courtesy and respect.
3. Perform duties willingly and with initiative; shares necessary information so co-workers can do the same.
4. Remain composed and takes actions to restore calm in stressful situations.
5. Demonstrate judgment and tact when dealing with others.
6. Cooperate with other hospital departments and work groups.
7. Communicate effectively with patients, visitors, and co-workers; take action to clarify information received from others.
Role Specific: Work role responsibilities
1. Work accurately and efficiently in a fast-paced environment utilizing computer/typing skills daily.
2. Process insurance remittances accurately and post into various systems.
3. Accurately post patient payments to various systems.
4. Translate medical jargon and abbreviations into proper form.
5. Organize, prioritize, distribute and track documentation.
6. Answer phones, schedule appointments and other office reception duties when required.
7. Operate office equipment.
8. Utilize understanding of HIPAA requirements when processing medical record requests.
9. Duplicates medical records, documents, forms and correspondence correctly when records requests are received.
10. Responsible for mailing and faxing copies of medical documents and reports to other physicians and patients.
11. Work well with others throughout the facility.
12. Performs other clerical duties as assigned.
Desired Knowledge, Skills & Abilities
1. Knowledge of state and federal regulations, policies, and procedures governing accounting, medical billing and financial recordkeeping.
2. Knowledge of general accounting principles and ability to produce, read and analyze financial reports
3. Knowledge of accounting and finance best practices and programs which enhance the financial success of the organization
4. Knowledge of financial/revenue cycle reporting and key performance indicators for measuring and benchmarking performance
5. Ability to operate various office equipment
6. Skill in accuracy and attention to detail
7. Ability to perform public relations and public speaking in a professional manner
8. Ability to maintain confidentiality
9. Ability to read, write legibly and calculate mathematical figures
10. Ability to solve practical problems and deal with a variety of variables
11. Ability to work with, lead and supervise others
12. Ability to manage multiple assignments/projects; meet timelines and prioritize responsibility
13. Ability to handle stressful situations and react appropriately
14. Ability to maintain a driver’s license and ability to travel distances for multiple days as necessary
15. Ability to exercise good judgement in appraising situations and making decisions
16. Ability to work and interact effectively and positively with other staff members to build and enhance teamwork across SLMC departments
17. Ability to communicate to complete responsibilities effectively
18. Ability to see to use computer efficiently and read computer reports and correspondence
19. High proficiency with Microsoft office products (excel, word, PowerPoint, etc.)
Equal Employment Opportunity
South Lincoln Medical Center will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual orientation or any other category protected by law.
Americans with Disabilities Act (ADA) Statement
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds.
Additional Information
Position Type : Full Time
Shift : Day
Hourly Wage: $19.00 - $22.00 per/hour
Contact Information
Nicole Micheli-Cowley - HR Business Partner
HR
Email: ncowley@slhd.org
Phone: 3072564367 |
