Preauthorization Spec

HMG; Johnson City (TN); On-site; USD 19,000 - 30,000; Full time

Job summary

Holston Medical Group is seeking a Preauthorization Specialist to obtain approvals for procedures or medications and to assist with scheduling and case management. The role involves coordinating with internal and external offices to gather patient information for insurance requirements and ensuring timely, accurate documentation of approvals and denials.

The position requires a high school diploma, familiarity with radiology terminology and CPT/ICD-9, and strong communication and organizational

Qualifications

• High school diploma or equivalent required.
• General understanding of Radiology procedures for ODC.
• Familiarity with CPT and ICD-9 terminology.
• Familiarity with computers and office equipment.
• Excellent communication and organizational skills.

Responsibilities

• Coordinate and schedule procedures based on orders and authorization approvals.
• Verify patient eligibility and coverage for the procedure.
• Obtain precertification/preauthorization from insurance companies.
• Counsel patients regarding authorization pending or denied and financial obligations.
• Maintain accurate records of insurance requirements, approvals, denials and pending cases.
• Interact with patients, physicians and staff to provide timely information.

Skills

Communication skills

Organizational skills

Teamwork

Medical terminology

Education

High School diploma or equivalent

Job description

Explore opportunities with Holston Medical Group, part of the Optum family of businesses. Holston Medical Group combines the personal feel of a community-based practice with the strength, resources and career opportunities of a leading national health care organization. As a multispecialty clinic offering care across northeast Tennessee and southwest Virginia, our teams deliver high‑quality, value‑based care that exceeds expectations while making care easier, more affordable and more accessible. Join us and discover the meaning behind Caring. Connecting. Growing together.

Pay Range: $16.00 - $22.50

General Summary: The Preauthorization Specialist is responsible for obtaining authorizations for procedures performed at the ODC or obtaining authorization for medications prescribed by providers . This position will work with internal or external offices to obtain patient information to complete insurance requirements for obtaining pre-authorizations for outpatient procedures or patients’ medication. This position will also assist in scheduling, task management and other duties as assigned.

Main Responsibilities:

• Coordinate and schedule patients’ procedures based on orders and authorization approvals.
• Verifies patient eligibility and coverage for the procedure using an online application or the telephone; if patient is not eligible on date of service, or procedure is not a covered benefit, explains this to patients.
• Obtains precertification/preauthorization from insurance companies prior to diagnostic radiology procedure, using an online application or by contacting insurer on the telephone.
• Counsels’ patients’regarding their potential choices when authorization is pending or denied, financial obligations
• Ensure efficient telephone communication
• Maintain accurate records of what insurance requires authorization and types of exams and what medication that requires authorization.
• Appropriate documentation of insurance approvals, denials and pending cases.
• Multi-tasking/cross training
• Maintain strict confidentiality in all matters relating to personnel and patient PHI (Protected Health Information)Need to obtain medication approval through insurance company
• Interact with patients, physicians and other staff within the offices to provide accurate, timely and responsive information
• Other duties as assigned

Education/Experience/Knowledge:

• High School diploma or equivalent required
• General understanding of Radiology procedures for ODC
• Must be familiar with Medical terminology. (CPT and ICD-9)
• Familiarity with computers and other office equipment.
• Must possess excellent communication and organizational skills
• Ability to work in a team environment and collaborate with others

Physical/Mental Demands:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential : Communication with others to exchange or express information and ideas. Ability to receive detailed information through oral communication, and to make fine distinctions in sounds. Determine the accuracy, neatness, thoroughness of the work assigned and perceive general observations. Remaining upright on the feet, particularly 75% of the time. Moving about on foot to accomplish tasks. Bending body downward and forward by bending spine at the waist and/ or by bending leg and spine. Extending the hands and arms in any direction. Exerting force upon an object so that an object moves away/toward the force. Picking, pinching, typing or otherwise working, primarily with fingers. Applying pressure to an object with the fingers and palm. Perform a variety of duties, often changing from one task to another of a different nature. Perform with frequent interruptions and/ or distractions. Make appropriate job decisions following standard office policies and past precedents. Adjust priorities quickly as circumstances dictate. Ability to establish and maintain cooperative working relationships with co-workers and the public. Ability to interact appropriately with colleagues and patients for different purposes and different context.

Marginal: Must be able to remain in a stationary position at least 25% of the time. Medium work that includes moving objects up to 50 pounds occasionally. Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. Work independently and identify potentially more effective methods of work operations. Observing an area that can be seen up and down or to right or left while eyes are fixed on a given point. Ability to identify and distinguish colors.

Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management reserves the right to revise the job or to require that other or different tasks be performed as assigned.

All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.