Patient Authorization Specialist

Steele Memorial Medical Center; Salmon (ID); On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Wellness initiatives

Free services at facility

Job summary

Steele Memorial Hospital is seeking a detail-oriented Prior Authorization Specialist to obtain insurance approvals for procedures, medications, tests, and treatments, ensuring timely patient care.

In this in-person role, you will work with providers, payers, and staff to minimize denials, review records, and prepare GFEs and ABNs, with emphasis on accuracy and compliance.

Qualifications

• Experience in insurance verification and prior authorization processes.
• Familiarity with Medicare/Medicaid and commercial payer requirements.
• Experience with EMR/EHR and billing systems.

Responsibilities

• Submit and track prior authorization requests with insurance carriers.
• Review medical records to ensure authorization requirements are met.
• Obtain authorizations for imaging, surgeries, and referrals as needed.
• Verify patient deductibles, coinsurance, and OOP information and document findings.
• Prepare GFEs for self-pay patients and coordinate with PFS team.

Skills

Prior authorization experience

Insurance verification

Medical billing

Communication skills

Organizational skills

Confidentiality

Education

High school diploma or equivalent

Associates degree preferred

Tools

EMR/EHR

Healthcare billing systems

Job description

Brief Description

Choosing Steele Memorial Medical Center as your employer will lead to a fulfilling career with ample opportunities for growth, community connection and meaningful impact. In our smaller rural setting, employee development and mentorship are a focal point in fostering a company culture that promotes professional growth.

Check out all that Salmon, Idaho has to offer at the link below!

Requirements

Salmon, Idaho Experience

NOTE: This is an in-person, onsite position WITHOUT the possibility of working remote.

NOTE: Please provide a written cover letter acknowledging understanding and willingness to work in-person as a local.

The Prior Authorization Specialist is responsible for obtaining insurance approvals for medical procedures, medications, tests, and treatments before services are provided. This role works closely with healthcare providers, insurance companies, patients, and clinical staff to ensure authorization requirements are met, minimize claim denials, and support timely patient care

Duties/Responsibilities

• Submit and track prior authorization requests with insurance carriers.
• Review medical records and documentation to ensure authorization requirements are met.
• Obtains prior authorization for O/P surgeries, CT, MRI, CT-guided biopsies, in-office procedures, specialty labs using insurance portals or by calling insurance, faxing all clinically pertinent information to insurance. If no auth is required, documents call reference number.
• May receive authorizations for imaging from outside providers/facility. May involve calling outside facility to get NPI, TIN, etc. for billing purposes.
• Obtains patient’s deductible, coinsurance, copay, and OOP maximum information and identify how much of each has been met/percentage, etc. Document in referral and email to PFS.
• Generates Good Faith Estimates (GFEs) for Self-Pay patients & forwards to PFS team for payment collection.
• Verifies CPT codes on Urology and Ortho for commercial insurance prior to continuing to authorization protocol.
• Ensure authorizations are received from work comp for imaging and surgeries.
• Verify &/or obtain prior authorization for all referrals for Specialty Clinic received from SMMC providers and outside providers.
• Verifies Infusion schedule for the following week to ensure all authorizations are active & within authorized dates.
• Prepare ABNs for Medicare patients that have non-covered services scheduled/ordered and discuss this with the patient.
• Triage referrals/orders based on time frame the services are needed and insurance turn-around time.
• Check pain management OR schedule prior to them faxing orders to ensure all orders have been approved.
• Work pre and post-service appeals, schedule per peer to peers as required.
• Follow up on pending, denied, or appealed authorization request.Maintain accurate records of authorization activities in electronic health record (EHR) system.
• Ensure compliance with payer policies, healthcare regulations, organizational procedures and patients receive timely access to approved healthcare services while maintaining compliance with insurance requirements and reducing delays, denials, and revenue cycle disruptions.
• May be required to start authorization with new CPT codes based on surgical procedures performed.

General Department Support

• Participate in departmental meetings, in-services, and training activities.
• Provide verbal and written reports to administration, committees, or leadership as requested.
• Promote positive customer service and professionalism when interacting with patients, visitors, payers, and staff.
• Support departmental quality improvement initiatives and productivity standards.
• Perform additional duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• High school diploma or equivalent; associates degree preferred.
• Previous experience in insurance verification, medical billing, or coding.
• Knowledge of insurance verification, prior authorization, and patient financial processes
• Experience with EMR/EHR and healthcare billing systems
• Understanding payer guidelines, Medicare, Medicaid, and financial assistance processes
• Strong organizational, communication, and customer service skills
• Ability to maintain confidentiality and manage multiple priorities in a fast-paced healthcare environment
• Familiarity with Medicare, Medicaid, and commercial insurance plans is beneficial.

Summary

At Steele Memorial Hospital we prioritize maintaining a healthy work-life balance, allowing our employees to enjoy their personal lives while pursuing their professional goals. As part of our benefit package, employees can access certain services at our facility free of charge and participate in our wellness initiatives to earn significant health deduction savings – potentially up to $1,100 annually!