Pre-Authorization & Insurance Specialist

Uniontown-Hospital; Uniontown (Fayette County); On-site; USD 25,000 - 39,000; Full time

Job summary

Uniontown Hospital in Uniontown, PA is seeking an Authorization Specialist to assure all appointments and procedures are pre-authorized or pre-certified. You will verify coverage, determine eligibility and benefits, and communicate estimated patient financial responsibility to patients and staff.

The role requires experience with EPIC, strong communication, and knowledge of medical terminology and coding. This on-site position supports scheduling and financial counseling to minimize

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal (if applicable), as required for regulated areas.

Responsibilities

• Identify patients requiring pre-certification or pre-authorization.
• Follow up on accounts as indicated by system flags.
• Contact insurance company or employer to determine eligibility and benefits.
• Communicate with patient and insurer to resolve eligibility issues.
• Use EPIC work queues for scheduling, transition of care, and billing edits.
• Perform medical necessity screening as required by third party payors.
• Document referrals/authorization/certification numbers in EPIC.
• Initiate charge anticipation calculations to identify anticipated self-pay.
• Explain anticipated self-pay portions to patient and coordinate with Financial Counselors if needed.
• Assist with denial management issues and appeals based on medical necessity.

Skills

Excellent communication

Medical terminology

ICD-10 CPT coding

Time of service collection

Customer service

Typing speed 25 wpm

Reading comprehension

Education

High school diploma or equivalent

Tools

EPIC system

Job description

Uniontown Hospital in Uniontown, PA is seeking an Authorization Specialist to assure all appointments and procedures are pre-authorized or pre-certified. You will verify coverage, determine eligibility and benefits, and communicate estimated patient financial responsibility to patients and staff.

The role requires experience with EPIC, strong communication, and knowledge of medical terminology and coding. This on-site position supports scheduling and financial counseling to minimize