Epic Authorizations Lead & Team Mentor

Whitman Hospital and Medical Clinics; Colfax (WA); Presencial; USD 33.000 - 58.000; Jornada completa

Descripción de la vacante

Whitman Hospital and Medical Clinics is seeking an Authorization Lead within Patient Financial Services to verify insurance, obtain prior authorizations, and ensure payer compliance for specialty and hospital services.

The role also mentors referral and authorization staff, serves as Epic superuser, supports process improvement, and collaborates with clinical and scheduling teams to minimize denials and maximize reimbursement.

Formación

• High school diploma or equivalent.
• Three (3) 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.
• Associate’s degree in business, healthcare administration, or related field.
• Five (5) years of experience in healthcare revenue cycle, referrals, authorizations, or patient financial services; Prior CAH or rural setting experience preferred.
• Knowledge of CMS guidelines, insurance payer contract compliance, and medical necessity criteria.
• Demonstrated leadership or lead role experience.

Responsabilidades

• Enter authorization information into the patient accounting system, including effective dates, authorized visits, patient information, billing information, and other authorization requirements.
• Ensure authorization has not expired for the scheduled patient visits.
• Communicates authorization information to appropriate staff as needed.
• 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.

Conocimientos

Payer authorization knowledge

Educación

High school diploma or equivalent

Associate’s degree in business, healthcare administration, or related field

Herramientas

Epic EMR

Descripción del empleo

Whitman Hospital and Medical Clinics is seeking an Authorization Lead within Patient Financial Services to verify insurance, obtain prior authorizations, and ensure payer compliance for specialty and hospital services.

The role also mentors referral and authorization staff, serves as Epic superuser, supports process improvement, and collaborates with clinical and scheduling teams to minimize denials and maximize reimbursement.