Authorization Lead & Epic Superuser

LE01 Whitman Hospital & Medical Clinics; United States; On-site; USD 68,770,000 - 120,347,000; Full time

Benefits offered by this job

Medical insurance

Dental and Vision insurance

Retirement options (403(b) & 457)

Shift differentials

PTO accrual growth

Job summary

Whitman Hospital & Medical Clinics in the United States seeks an Authorization Lead to handle insurance verifications, secure prior authorizations, and ensure payer compliance for hospital services. The role also guides staff, trains on Epic workflows, and collaborates with clinical and business teams to minimize denials and optimize reimbursement.

The position requires experience in healthcare revenue cycle and proficiency with Epic; leadership skills are essential for mentoring and overseeing

Qualifications

• Three years of experience in healthcare revenue cycle, referrals, authorizations, or patient financial services.
• Proficiency in Epic or similar EMR system.
• Strong knowledge of payer authorization and referral requirements.
• Five years of experience in healthcare revenue cycle, referrals, authorizations, or patient financial services.
• Demonstrated leadership or lead role experience.
• Knowledge of CMS guidelines, insurance payer contract compliance, and medical necessity criteria.
• Preferred Associate’s degree in business, healthcare administration, or related field.
• Prior experience in a Critical Access Hospital (CAH) or rural healthcare setting.

Responsibilities

• Enters authorization information into the patient accounting system, including effective dates, authorized visits, patient information, billing information, and other authorization requirements.
• Ensures authorization has not expired for the scheduled patient visits.
• Follows proper patient/beneficiary notice procedures for potential non-coverage.
• Obtains authorizations from insurance companies/physicians/medical benefits Management Company.
• Coordinates with billers regarding denials.
• Researches denials and facilitates retro-authorization or appeals.
• Reviews authorization-related denials and coordinates corrective actions with staff and departments.
• Works with providers and schedulers to prevent denials (e.g., CPT/diagnosis mismatches, missing authorizations).
• Tracks and reports denial trends, providing recommendations to leadership.
• Identifies workflow gaps and implements process improvements to streamline referral and authorization functions.
• Ensures compliance with CMS, Medicaid, Medicare Advantage, and commercial payer regulations.
• Collaborates with Revenue Cycle leadership to support organizational goals (e.g., reducing denial rates, improving cash flow).
• Reviews daily work queues to ensure timely completion of referrals and prior authorizations.
• Monitors scheduled and unscheduled services to confirm payer requirements are met before patient care.
• Ensures urgent and same-day authorization requests are prioritized and completed efficiently.
• Provides expertise to staff on payer-specific rules, medical necessity, and documentation requirements.
• Trains, mentors, and supports staff on Epic referral/authorization workflows, payer requirements, and hospital policies.
• Provides team performance feedback to supervisor as requested.
• Acts as a liaison between clinical areas, Patient Financial Services, and the Business Office teams.

Skills

Healthcare revenue cycle

Payer authorization

Leadership experience

CMS guidelines knowledge

Education

High school diploma or equivalent

Associate’s degree preferred

Tools

Epic

Job description

Whitman Hospital & Medical Clinics in the United States seeks an Authorization Lead to handle insurance verifications, secure prior authorizations, and ensure payer compliance for hospital services. The role also guides staff, trains on Epic workflows, and collaborates with clinical and business teams to minimize denials and optimize reimbursement.

The position requires experience in healthcare revenue cycle and proficiency with Epic; leadership skills are essential for mentoring and overseeing