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Pre Authorization Clerk

CHI St. Alexius Bismarck

Overview:Since 1885, CHI St. Alexius Health has been dedicated to leading health care in this region by enriching the lives of patients through the highest quality of care. We seek to continue our tradition of success and innovation with individuals dedicated to delivering the highest level of expertise and quality. Together we can continue to grow and support the legacy of CHI St. Alexius Health for many years to come. CHI St. Alexius Health is a regional health network with a tertiary hospital in Bismarck, the system also consists of critical access hospitals (CAHs) in Carrington, Dickinson, Devils Lake, Garrison, Turtle Lake, Washburn and Williston and numerous clinics and outpatient services.  CHI St. Alexius Health manages four CAHs in North Dakota – Elgin, Linton, and Wishek, as well as Mobridge Regional Medical Center in Mobridge, S.D. CHI St. Alexius Health offers a comprehensive line of inpatient and outpatient medical services, including: a Level II Trauma Center, primary and specialty physician clinics, home health and hospice services, durable medical equipment services, a fitness and human performance center and ancillary services throughout western and central North Dakota. CHI St. Alexius Health is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. CommonSpirit Health is committed to creating healthier communities, delivering exceptional patient care, and ensuring every person has access to quality health care.Responsibilities:Essential Key Job ResponsibilitiesEnsure required referrals and/or authorizations are obtained prior to service for clinic procedures/infusions. Contact insurers to verify benefit levels and patient pay obligations.Reviews denied or reduced payments identified by billing staff for appropriate action. Completes necessary written or telephone appeals to increase reimbursement. Works with billing staff to assure appeals are completed timely.Establish a cooperative working relationship with external third party payers, Blue Cross and Medicare/PHS and medical center departments.Demonstrate knowledge of insurance and financial issues.Uses professional skills when handling calls and inquires by patients and coworkers. Must be able to research or re-direct questions to appropriate staff if unable to help. Maintain a direct line of communication between hospital and clinic fiscal departments, to keep client information as accurate as possible. Demonstrates organizational skills and pride within the department.Consistently shows willingness to assist patients and employees regarding coding and reimbursement inquiries in a kind and courteous manner. Demonstrates willingness to educate patients and employees regarding coding process.Consistently makes self-available to patient and coworkers by closely following hospital policy regarding personal phone calls and internet use.Consistently responds in a prompt manner to all requests for information, verbal or written.Demonstrates pride in the department by keeping work area clean and organized. Consistently keeps garbage emptied, shredding bins emptied, assists in equipment maintenance.Consistently demonstrates self-learning skills by keeping self-informed of coding and reimbursement regulations by reading newsletters, journals, articles, and coding or insurance payer websites.Qualifications:Minimum QualificationsRequired Education (for CHI Leadership Job Levels from Supervisor through President) Two year associate degree in business/medical administration, medical secretary or medical records technician course. Additional directly related work experience may substitute for the education requirement on a year-for-year basis.Required Licensure and Certifications None required. CPC or CCS-P preferredRequired Minimum Knowledge, Skills and AbilitiesMedical insurance knowledge, able to use computer programs like Microsoft Word, Excel, and Google. Ability to multi-task, superior organizational skills, ability to remain focused in an environment with many repeated distractions and interruptions, ability to de-escalate and handle stressful situations, promote a philosophy of teamwork, ability to view the big picture to visualize how requests will impact patients, providers, and other schedules.PREFERRED QualificationsMinimum of 3 years coding/billing, insurance verification, office support, healthcare or clerical work experience.