On-Site Prior Authorization & Patient Access Specialist

Wyohospitals; Newcastle (WA); On-site; USD 42,000 - 64,000; Full time

Job summary

Weston County Health Services (WCHS) is seeking a full-time Pre/Prior Authorization Specialist for its on-site locations in Newcastle, WY. The role coordinates insurance authorizations and pre-certifications to ensure services are approved before delivery, supporting financial clearance and patient experience.

Reports to the Chief Financial Officer. Responsibilities include verifying eligibility, determining authorization needs, and communicating with payers and clinical staff to avoid denials.

Qualifications

• Two years’ experience in a medical business office, patient registration, or health care setting involving insurance verification, authorization, or patient-facing customer service.
• Knowledge of insurance verification, pre-certification, and prior authorization requirements for Medicare, Medicaid, and commercial payers.
• Completion of post-secondary coursework in medical terminology and CPT/diagnosis coding, or graduation from a medical assistant, health unit coordinator, or health care business services program, preferred.
• Proficiency with electronic health record and patient registration/accounting systems.

Responsibilities

• Verifies patient insurance eligibility, coverage, and benefits prior to scheduled services.
• Determines pre-certification and prior authorization requirements for scheduled services across all departments.
• Obtains and secures required authorizations, pre-certifications, and referrals from third-party payers before services are rendered.
• Enters authorization numbers and related information into the registration and patient accounting system.
• Maintains knowledge of payer-specific authorization requirements and timelines.

Skills

Analytical skills

Communication skills

Interpersonal skills

Organizational skills

Time management

Attention to detail

Prioritization

Integrity & confidentiality

EHR systems

Math skills

Education

High School Diploma

Medical terminology / CPT coding coursework

Tools

Electronic Health Record (EHR) systems

Job description

Weston County Health Services (WCHS) is seeking a full-time Pre/Prior Authorization Specialist for its on-site locations in Newcastle, WY. The role coordinates insurance authorizations and pre-certifications to ensure services are approved before delivery, supporting financial clearance and patient experience.

Reports to the Chief Financial Officer. Responsibilities include verifying eligibility, determining authorization needs, and communicating with payers and clinical staff to avoid denials.