Patient-Focused Prior Authorization Specialist

Vista Healthcare; Saint George (UT); On-site; USD 36,000 - 54,000; Full time

Job summary

Vista Healthcare is seeking a detail-oriented Medical Prior Authorization Clerk in St George, UT. The role involves handling patient and physician calls, entering data into our clinical/non-clinical systems, and reviewing orders against insurance criteria for pre-certification.

You will contact physicians for missing documentation, coordinate with insurers, and keep patients informed on order status and scheduling once approved.

Qualifications

• Six months of prior authorization experience preferred; training provided.

Responsibilities

• Answer calls from patients and physician offices with excellent customer service.
• Enter required information into computer database (clinical and non-clinical).
• Review clinical data and authorize requests for further review per procedures.
• Check orders for insurance coverage; determine if pre-certification is warranted.
• Follow up with physicians for missing documentation to complete orders.
• Pre-certify/authorize procedures with insurers as ordered by the referring physician.
• Communicate updates to ordering physicians when denials occur and assist with peer reviews.
• Inform patients about order receipt and scheduling once insurance is approved.
• Monitor pre-certification status for timely processing.
• Log orders in authorization spreadsheets and schedule procedures when approved.
• Maintain patient confidentiality per regulations.
• Foster effective relationships with staff, providers, and patients.

Skills

Customer service

Medical terminology

Team collaboration

Independent work

Attention to detail

Education

High School Education or GED

Tools

Computer database entry

Job description

Vista Healthcare is seeking a detail-oriented Medical Prior Authorization Clerk in St George, UT. The role involves handling patient and physician calls, entering data into our clinical/non-clinical systems, and reviewing orders against insurance criteria for pre-certification.

You will contact physicians for missing documentation, coordinate with insurers, and keep patients informed on order status and scheduling once approved.