Remote Optum Prior Authorization Jobs in Rochester, MN

The HIMS Senior Specialist should have a broad knowledge of an electronic health record (EHR), specifically Epic.  The individual should have a firm understanding of HIPAA-compliance and when an authorization is needed before disclosing protecting health information.  Responsible for the comprehensive processing of all types of requests for medical information to include customer service for walk-ins, opening and processing incoming mail, verifying authorizations, requesting historical medical records, and preparing correspondence in response to a request for medical information. In addition, this individual is responsible for the completion of quality assurance monitoring of the work performance of HIMS Specialists and reporting their findings to the HIMS Supervisor.  Acts as a resource for the HIMS Specialist and completes ad-hoc projects. The HIMS Sr. Specialist will also assist with training new or contract staff and students in a qualitative and effective manner.  Prefer that the candidate has prior ROI experience and customer service experience. 

Supports patient safety and quality care by being knowledge experts of the health care record achieved through quality documentation, integrity of the EHR, timely and accessible health information, regulatory compliance. Coordinates and maintains the flow and content of patient health information in both paper and electronic formats. Analyzes patient information to ensure compliance with standards established by Federal/State & Joint Commission & CMS regulations. Coordinates with clinicians to ensure documentation contains all required elements and is completed in a timely manner. Adheres to, and helps develop, institutional policies regarding health care documentation. Utilizes independent analytical and critical thinking skills. Works independently and collaboratively across the enterprise with minimal supervision. Adheres to guidelines with regard to accessing minimum necessary information to complete job function. Adheres to state and federal rules regarding privacy and confidentiality of protected health information. Leverages technology to serve the patients and practice. Assists in developing and training HIMS operational teams. Professionally communicates through all electronic, written, and verbal methods. Ensures great customer service while assisting patients, care providers, allied health staff, attorneys, insurance companies, government audits, and others in a courteous, professional and confidential manner.

This is a hybrid position that is primarily remote. Candidates must reside within 100 miles of a Mayo Clinic campus to meet occasional on-site requirements based on business needs. Mayo Clinic campuses are located in Arizona, Florida, Minnesota, and Wisconsin

**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.

During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.

Associate's degree in Health Information Technology. Health Information Technician (HIT) program students actively completing the last semester of the program will be considered; successful completion of HIT program required within 6 months of employment for continued employment.Demonstrated understanding of Joint Commission standards, State Regulations, and CMS requirements. Must possess knowledge of medical records format and content with the ability to perform work in a fast paced, constant change, production environment with a focus on quality. Must possess excellent customer service skills and be able to clearly, concisely and professionally communicate verbally and in written forms. Demonstrated ability to maneuver in multi technology environment and demonstrates proficiency in Microsoft Office (Excel, Word, Outlook) applications. Keyboarding skills required with intermediate typing/keyboard/computer skills. Versed in government regulatory and legal healthcare requirements to protect the patient and organization. Demonstrated medical terminology knowledge and basic project management skills. RHIT or RHIA certification required.