Prior Authorization Clerk - Full Time

Three Crosses Regional Hospital; Las Cruces (NM); On-site; USD 21,000 - 30,000; Full time

Job summary

Three Crosses Regional Hospital is seeking a dedicated Prior Authorization Clerk to ensure accurate patient registration and timely information collection. You will verify insurance eligibility, review deductibles, and collaborate with schedulers to resolve discrepancies while maintaining HIPAA compliance.

The role emphasizes teamwork, confidentiality, and supporting a patient-centered culture within the hospital environment.

Qualifications

• Requires high school diploma or equivalent.
• Preferred: 1 year of hospital customer service experience.

Responsibilities

• Maintain patient demographic information and data collection systems.
• Verify insurance eligibility for upcoming appointments using online portals or carrier contacts.
• Review patient deductibles and/or copays and record in EHR and front-end spreadsheets.
• Coordinate with schedulers on discrepancies.
• Assist front-end staff in understanding carrier websites and eligibility verification.
• Enter insurance correspondences as needed.
• Contribute to development and update of SOPs and manuals.
• Answer questions from patients, clerical staff, and insurers.
• Work with schedulers and financial counselors to ensure clean billing.
• Attend staff meetings and engage in continuous education.

Skills

Customer service

Team collaboration

HIPAA compliance

Education

High School Diploma or equivalent

Tools

Electronic Health Record (EHR)

Job description

If you're looking for a place to call home and grow, Three Crosses Regional Hospital is looking for you! We are looking for a Prior Authorization Clerk that is committed to clinical excellence and building a patient-centered culture.

The Prior Authorization Clerk will ensure the quality of patient registration to the hospital by obtaining thorough and accurate information in a timely and efficient manner. Follows up on accounts that require further evaluation. Works well in a team environment.

The incumbent will carry-out her/his duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of Three Crosses Regional Hospital, and fully supports the mission, vision, and values of Three Crosses Regional Hospital. The incumbent will have knowledge of health care systems, and have demonstrated ability to interact, relate to, work with, and support the activities of a diverse workforce.

PrimaryResponsibilities

• Maintains patient demographic information and data collection systems.
• Verify insurance eligibility for medical insurances for upcoming appointments by utilizing online websites or by contacting the carriers directly.
• Review patient deductibles and/or copays and enter in the Electronic Health Record and spreadsheets provided to the front-end department
• Coordinate with schedulers regarding any discrepancies.
• Assist front end staff in understanding carrier websites and verification of eligibility.
• Enter insurance correspondences as needed.
• Participates in development of organization procedures and update of forms and manuals.
• Answers questions from patients, clerical staff and insurance companies.
• Works in conjunction with schedulers and financial counselors to ensure clean billing.
• Performs miscellaneous job-related duties as assigned.
• Participates in educational activities and attends monthly staff meetings.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Assists in development and communication of SOP for key areas to improve accuracy and understanding of processes.
• Attends staff meetings as needed.
• All other duties as assigned by department manager/director.

Education and Experience

• Required:High School Diploma or equivalent
• Preferred: 1 year of customer service experience in hospital setting