Pre-Access Authorization Consumer Access Specialist

AdventHealth Gordon; Chatsworth (GA); On-site; USD 22,000 - 35,000; Full time

Benefits offered by this job

Benefits from Day One

Parental Leave

Career Development

Well-being Resources

Job summary

AdventHealth in Calhoun, GA seeks a detail-oriented professional to manage prior authorizations and communications with payers. You will document medical necessity, verify patient data, and coordinate with clinical teams to ensure smooth approval processes.

The role emphasizes accurate EMR entry, HIPAA confidentiality, and collaboration across departments to maintain payment accuracy and timely service delivery.

Qualifications

• High School graduate or equivalent required.
• Experience reviewing documentation and ensuring compliance with payer guidelines is desirable.

Responsibilities

• Obtains prior authorization or pre-certification for services for payment by insurers, including CMS and state programs.
• Submits clinical documentation for payor approval and ensures medical necessity criteria are met.
• Acts as liaison with clinical care team to ensure payer guidelines compliance.
• Coordinates communication between business and clinical operations; verifies eligibility and benefits as needed.

Skills

Validation

Education

High School Grad or Equiv

Job description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

1035 RED BUD RD NE

City:

CALHOUN

State:

Georgia

Postal Code:

30701

Job Description:

• Obtains prior authorization or pre-certification of services for payment by insurance companies, including CMS and state programs.
• Submits clinical documentation for approval to payors and ensures medical necessity criteria are met.
• Acts as a liaison with the clinical care team to ensure compliance with payer guidelines.
• Participates in clinical performance improvement initiatives related to documentation and quality utilization.
• Coordinates communication between business and clinical operations. Distributes information to ancillary departments and verifies eligibility and benefits as needed.
• Accurately documents prior authorization information in EMR and other systems. Communicates with physician offices regarding the status of requests.
• Ensures all scheduled testing meets Medicare medical necessity standards. Obtains patient demographic and insurance information from new patients and enters it into the computer.
• Treats patients and their families with respect and dignity while ensuring confidentiality of patients’ records.
• Provides information about patient rights and HIPAA.
• Other duties as assigned.

Knowledge, Skills, and Abilities:

• Validation [Required]

Education:

• High School Grad or Equiv [Required]

Field of Study:

• or GED

Physical Requirements:

• Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$16.05 - $25.67

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.