Prior Authorization Pro: Epic Referrals & Payer Approvals

Lexington Medical Center; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Day ONE benefits

403(b) match plan from day one

Employer paid life insurance

Job summary

Lexington Health in South Carolina seeks a PN Access and Authorizations specialist to accurately authorize referrals before patient appointments. You will use Epic and Experian Real Time Authorization (RTA) to secure imaging and specialty service approvals, updating records and communicating with departments.

The role requires a High School Diploma or equivalent and at least 6 months of referral/authorization experience, plus strong medical terminology and ICD-10/CPT knowledge.

Qualifications

• Minimum Education: High School Diploma or Equivalent.
• Minimum Years of Experience: 6 months of referral and/or authorization experience.
• Substitutable Education & Experience: None.
• Required Certifications/Licensure: None.
• Required Training: Strong Medical Terminology and Insurance Knowledge; Knowledge of ICD-10 and CPT Coding.

Responsibilities

• Understands the referral process start to finish and acknowledges authorization as an important step in the overall process.
• Meets authorization volume and quality standards set monthly.
• Thoroughly reviews patient charts in Epic, submits the appropriate clinicals for authorization to the correct payer/third party vendor, obtains final determination from payer and enters information into EPIC.
• Utilizes Experian RTA system to obtain authorization and verifies authorization completion within system.
• Communicates all necessary authorization updates and status changes to the appropriate department(s).
• Communicates peer-to-peer requests to PN practices for providers/clinical staff to complete in order to obtain an authorization from payer.

Skills

Medical terminology

Insurance knowledge

ICD-10 coding

CPT coding

Communication

Education

High School Diploma or Equivalent

Tools

Epic Referral Work Queues

Experian Real Time Authorization (RTA)

Job description

Lexington Health in South Carolina seeks a PN Access and Authorizations specialist to accurately authorize referrals before patient appointments. You will use Epic and Experian Real Time Authorization (RTA) to secure imaging and specialty service approvals, updating records and communicating with departments.

The role requires a High School Diploma or equivalent and at least 6 months of referral/authorization experience, plus strong medical terminology and ICD-10/CPT knowledge.