Prior Authorization Lead

You belong here! At Family Health West, you’re more than an employee, you’re family. 

When you enter our facility, you know it’s Family Health West because, well, the color speaks for itself. You’ll be part of a team that strives to bring color to care in a vibrant environment by creating fun, effective treatment programs helping to empower and inspire our patients while providing the tools and care they need to achieve their wellness goals. 

When we say you’ll do what you love, we mean it! Welcomed by open arms and warm smiles, you’ll join a team that encourages professional growth. We are sure to put on our listening ears when you share new ideas and approaches to care because that’s what got us to the top! You’ll wear your badge proudly, knowing that you contribute each day, to providing care that is unmatched, in western Colorado.

So, what are you waiting for?! Fill out the application now, and when you hit send do a little happy dance knowing that you just made our day. If it still sounds too good to be true, come see for yourself. Call us to schedule a tour and meet your new best friends!

About Family Health West

Our roots go deep -- founded by the community in 1946, it’s no wonder our hospital feels like coming home. We were built from the ground up with the hands of our own community, a labor of dedication and hope by our people, for our people, for the future. 

At Family Health West we go beyond what corporate hospitals deliver, we’ve created a culture of prosperity where warmth, passion, and care flourishes. As we focus on continually improving outcomes for patients, our network of healthcare providers includes a 25-bed critical access hospital, one of the largest rehab providers in western Colorado, outpatient surgical services, specialty clinics, emergency services, skilled nursing, and assisted living facilities.

Nestled at the base of the Colorado National Monument, Family Health West has an outdoor paradise at your back door. The community culture is fitting for outdoor lovers, bikers, hikers, or those just simply soaking in the panoramic views.

Essential Functions

• Reliable and punctual attendance is essential; expected to be at job as scheduled each scheduled day.
• Communicate necessary information to others as appropriate.
• Answer phone calls from physician offices, hospitals, and patients using exceptional customer service skills in a timely and efficient manner.
• Accurately enter patient information into computer in a timely and efficient manner.
• Verify insurance eligibility on all patients prior to their scheduled appointment in an efficient and timely manner.
• Scan all documentation into patient electronic chart in a timely and efficient manner.
• Request any necessary documentation/information from outside providers to complete prior authorizations.
• Obtain prior authorization by calling patients insurance company, assisting patients with questions and offering assistance.
• Develop strong organizational structure, workflow and operating procedures for department under the directing of the Coordinator/Manager
• Prepare and send all referrals/documentation to outside providers
• Update EHR with prior authorization numbers, insurance information and any other relevant information.
• Maintain patient confidentiality
• Participate in department workshops & training.
• Assist department with scheduling.
• Establish effective rapport with other employees, patients, physicians, vendors, etc.
• Work collaboratively with other departments.
• Follow all standard operating procedures.
• Use of Excel & reporting tools.
• Communicate with understanding, patience, respectfulness & kindness to help to promote a positive atmosphere.
• Expert knowledge of Medical service lines in Hospital Services and Physician Services.
• Expert problem solving skills.
• Check the mail box in the SSB Mail Room daily, distribute mail to appropriate employee as needed.
• First Resource for the Prior Auth Team; Answer questions, research for answers if unknown.
• Support and assist the Prior Auth Team in all areas of the prior authorization process, jump in and help if they fall behind.
• Assist in training New Employees.
• Responsible for cross training employees in other departments.
• First back up to cover employees that are out for any reason.
• Assist Revenue Cycle Manger with New Employee Orientation for Prior Authorization Department.
• Responsible for pushing out and tracking new policies for insurance companies.
• Research guidelines for new procedures, let Prior Auth team know what the guidelines are.
• Monitor Prior Authorization Statuses in a timely manner.
• Learn and Understand processes and procedures for all Medical Service Departments that Prior Authorization touches, Physician Services and Hospital Line, 15 Medical Service Departments total.
• Review end of month therapy billing data, billing outside of month charges & report to the Revenue Cycle Manager.
• Assist Revenue Cycle Manager with therapy implementation of new codes, integration between software programs, updates & filling optimization.
• Monthly therapy reports & running macros to ensure units match between billing software programs.
• Other job related duties as assigned.

Wage Range

Wage starts at $21.00

Immunizations required for employment

Benefits

FHW offers a full benefits package including:
FOR ALL EMPLOYEES:
Employee Assistance Program
403 (B) with 4% match from FHW and zero day vesting schedule
FOR FULL TIME EMPLOYEES WORKING AT LEAST 30 HOURS A WEEK
Medical Plan Options:
I. PPO plan with copay/coinsurance and lower deductible
II. High Deductible Health Plan with the option for a Health Savings Account.
III. Telemedicine includes in both plan options.
Dental
Vision
Life Insurance/ Accidental Death and Dismemberment Insurance
Disability Insurance with a Short and Long Term Option.
Critical Illness and Accident Plans
Cafeteria Options: Health Reimbursement/ Flex Savings / Dependent Childcare

A host of other options to include: Pet Insurance, Identity Protection, Travel protection.

Salary : $21