Insurance & Prior Authorization Specialist

Munson Healthcare Careers; Michigan; Hybrid; USD 42,000 - 56,000; Full time

Job summary

Munson Healthcare is seeking an Insurance Prior Authorization Specialist to help patients access care by navigating insurance requirements and obtaining authorizations. You will verify medical necessity, coordinate clinical reviews and appeals, and partner with providers, payers, and financial teams to remove barriers and keep services moving.

As part of a collaborative team, you will identify process improvements, educate teammates, and ensure work is completed accurately and efficiently with

Qualifications

• Associate’s degree in Health Services Administration or related field preferred; degree optional with 3 years revenue cycle experience.
• Successful completion of Medical Terminology and Anatomy courses required.
• Knowledge of current third-party payer reimbursement rules required.

Responsibilities

• Navigate insurance requirements to obtain authorizations.
• Verify medical necessity and coordinate clinical reviews and appeals.
• Partner with providers, payers, and clinical/financial teams to resolve barriers.
• Identify process improvements and educate team members; ensure work is accurate and efficient with patient experience in mind.

Skills

Revenue cycle experience

Payer rules knowledge

Medical terminology

Education

Associate’s degree in Health Services Administration or related field

Medical Terminology course

Anatomy course

Job description

Company Description

*Michigan residents*

More Than Just Care,It’sCommunity

Imagine doing meaningful work in a place where peoplevacation.That’slife at Munson Healthcare - northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties.

If you want a career in healthcare and alifestylemost people only dream about – with freshwater lakes, scenic trails, charming downtowns, a vibrant arts scene, and endless outdoor adventures - you might just beMunson Material.To us, that means teammates who live by our values ofexcellence,teamness, positivity, creativity,and a commitment to creatingexceptional experiencesfor our patients and each other. Join a team that delivers outstanding care in one of the most beautiful regions in the country.

Invested in You

• Grow:Tuition reimbursement, in-person and onlinedevelopment,and access to ourcareer hubto help you advance.
• Thrive:Full benefits, paid holidays, generous PTO, employee discounts, and freeindividualretirement counseling.
• Be Well:Freewellness platform for you and your family,pluspersonalizedsupport for personal or family challenges.
• Be Heard:Share your ideas and help shape the way we work through improvement huddles, employee surveys, and town hall meetings

Job Description

As an Insurance Prior Authorization Specialist, you will be focused on helping patients access the care they need by navigating insurance requirements, obtaining authorizations, verifying medical necessity, coordinating clinical reviews and appeals. You will partner closely with providers, payers, and clinical and financial teams to resolve barriers, manage changing priorities, and keep services moving forward, while also using their expertise to identify process improvements, support and educate team members, and ensure work is completed accurately, efficiently, and with the patient experience in mind

Qualifications

• Associate’s degree in Health Services Administration or Business related field preferred. In lieu of degree, 3 years internal revenue cycle experience will be considered, or one year internal insurance verifier. Minimum productivity requirements, and peer review process are required.
• Successful completion of Medical Terminology course, and Anatomy course is required.
• Knowledge of current third-party payer reimbursement rules required.

Additional Information

Areyou Munson Material? Apply today!

Munson Healthcare requires all employees be vaccinated or have lab confirmed immunity for Measles, Mumps, Rubella and Varicella. MHC also requires all employees to receive a flu vaccine during the flu season in the year that they are hired and annually thereafter, or receive an approved medical or religious exemption.