Prior Authorization Pro — Healthcare Benefits & Procedures

Talentify; Sheridan (WY); On-site; USD 42,000 - 56,000; Full time

Job summary

Sheridan Memorial Hospital is seeking a Medication / Procedure Prior Authorization Specialist to verify benefits and obtain required approvals for medications and procedures. You will contact insurers, provide documentation, and support clinicians and patients throughout the authorization process.

The role requires knowledge of CPT/HCPCS/ICD-10 coding, strong communication skills, and experience in a hospital or billing environment. Minimum 3–5 years preferred; HIPAA compliance is essential.

Qualifications

• High school diploma or equivalent is required.
• Knowledge of CPT, HCPCS, and ICD-10 codes preferred.
• Medical terminology is required.
• 3–5 years in a hospital, clinic, or billing setting.

Responsibilities

• Obtain pre-authorizations/pre-certification per payer requirements.
• Determine CPT, HCPCS and ICD-10 codes for authorizations.
• Explain insurance co-pays, deductibles, and out-of-pocket costs.
• Communicate authorization status with providers, staff, and patients.
• Assist billing with researching denied claims and follow-up.

Skills

Communication

Teamwork

Customer service

Attention to detail

Problem solving

Time management

Education

High school diploma

Medical terminology

CPT/HCPCS/ICD-10 knowledge

Hospital billing experience

Tools

EMR system

MS Office

Job description

Sheridan Memorial Hospital is seeking a Medication / Procedure Prior Authorization Specialist to verify benefits and obtain required approvals for medications and procedures. You will contact insurers, provide documentation, and support clinicians and patients throughout the authorization process.

The role requires knowledge of CPT/HCPCS/ICD-10 coding, strong communication skills, and experience in a hospital or billing environment. Minimum 3–5 years preferred; HIPAA compliance is essential.